目的 构建并评价儿科患者病情恶化早期风险评估及预警决策支持系统(intelligent risk assessment and early warn-ing system，IRA-EWS)。方法 以临床决策支持系统参考模型(clinical decision support system-reference model，CDSS-RM)为理论框架，以半结构式访谈提炼 IRA-EWS功能清单，以专家论证会讨论完成系统设计。采用临床护理信息系统有效性评价量表进行 IRA-EWS的应用评价。结果 IRA-EWS包括以下功能:颜色预警，以红黄绿代表高中低程度的病情恶化预警级别;评估触发，基于结构化字段自动触发儿童早期预警评分(pediatric early warning score，PEWS)评估;决策支持，基于不同预警级别的护理计划予以决策支持;趋势展示，以可视化图表呈现单次住院周期内PEWS评分趋势;数据共享，医护实时共享中高风险预警。临床护士对 IRA-EWS的使用体验平均得分为(97。46±0。90)分，得分最高的维度是"用户满意"，最低的是"系统质量"。结论 基于 CDSS-RM并评估临床护士需求，IRA-EWS的构建过程是科学的，护士对 IRA-EWS有良好体验，后续还需对其是否可以改善患者结局作有效性评价。
Construction and Application Evaluation of Clinical Decision Support System of Early Warning for Pediatric Deterioration
Objective To develop and evaluate an Intelligent Risk Assessment and Early Warning System(IRA-EWS)for pediatric deterioration.Methods The clinical decision support system reference model(CDSS-RM)was used as the theoretical framework.The list of functions of IRA-EWS was refined through semi-structured interviews,and the system was designed through expert discussion and validation.The clin-ical nursing information system effectiveness evaluation scale was used to evaluate the application of IRA-EWS.Results The IRA-EWS included the following functions:color alerts with red,yellow and green re-presenting high,medium and low deterioration alert levels;assessment triggers,which automatically trig-gered the Pediatric Early Warning Score(PEWS)assessment based on structured fields;decision support,which provided decision support based on nursing plans of different early warning levels;trend display,which visualized the trend of PEWS scores in a single hospitalization cycle;data sharing,which was a real-time sharing of medium-and high-risk early warning between doctors and nurses.The average score of clin-ical nurses'experience of using IRA-EWS was 97.46±0.90,with the highest score being"user satisfac-tion"and the lowest being"system quality".Conclusions Based on CDSS-RM and the evaluation of the needs of clinical nurses,the construction process of IRA-EWS is scientific.Nurses have a favorable experi-ence of using IRA-EWS and it is necessary to evaluate its effectiveness in improving patient outcomes in the future.
pediatric early warning scoreclinical decision support systemnursing information
NETL
NSTL
万方数据
维普
