Mrs. Jones is an 89 year old woman who was found on the floor of her home. She states that she got dizzy and sat on the floor and did not fall. She was brought in for observation and testing. Dr. Smith reviews the nursing history in the EHR and the patient’s first assessment. While he is placing orders in the chart, he is given an electronic alert by the clinical information system to remind him that he may want to order a MRI of the brain to rule out a CVA. The alert was prompted by the patient’s diagnosis, her age, and the patient assessment completed by the nurse. Dr. Smith cancels the alert because he believes that observation of the patient and reevaluation of her status in the morning will suffice. As he walks on the floor the next morning, the nurse signals to him frantically to come and see Mrs. Jones. It appears that she has had a major CVA. Dr. Smith knows that this may have happened with or without Mrs. Jones having had the MRI the day before, but he is concerned about the ramifications of his canceling the alert the day before.
• Dr. Smith cancelled that alert because he felt that it was not clinically necessary. How did the CIS ‘know’ that an MRI of the brain is/was an appropriate intervention?
• What are the potential ramifications for Dr. Smith canceling the alert? • Discuss the effectiveness of CPOE and clinical decision support systems (CDSS) related to patient care for nurses. • Describe the challenges faced in the clinical environment with the use of CPOE and CDSS. • Discuss the ethical decision making the clinician faces when deciding to cancel an alert.
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