Successfully Transitioning an Interruptive Alert into a Noninterruptive Alert for Central Line Dressing Changes in the Neonatal Intensive Care Unit

Abstract

Background Interruptive alerts are known to be associated with clinician alert fatigue, and poorly performing alerts should be evaluated for alternative solutions. An interruptive alert to remind clinicians about a required peripherally inserted central catheter (PICC) dressing change within the first 48 hours after placement resulted in 617 firings in a 6-month period with only 11 (1.7%) actions taken from the alert.

Objectives This study aimed to enhance a poorly functioning interruptive alert by converting it to a noninterruptive alert aiming to improve compliance with the institutional PICC dressing change protocol. The primary outcome was to measure the percentage of initial PICC dressing changes that occurred beyond the recommended 48-hour timeframe after PICC placement. Secondary outcomes included measuring the time to first dressing change and, qualitatively, if this solution could replace the manual process of maintaining a physical list of patients.

Methods A clinical informatics team met with stakeholders to evaluate the clinical workflow and identified an additional need to track which patients qualified for dressing changes. A noninterruptive patient column clinical decision support (CDS) tool was created to replace an interruptive alert. A pre–postintervention mixed-methods cohort study was conducted between January 2022 and November 2022.

Results The number of patients with overdue PICC dressing changes decreased from 21.9% (40/183) to 7.8% (10/128) of eligible patients (p < 0.001), and mean time to first PICC dressing changes also significantly decreased from 40.8 to 30.7 hours (p = 0.02). There was a universal adoption of the CDS tool, and clinicians no longer used the manual patient list.

Conclusion While previous studies have reported that noninterruptive CDS may not be as effective as interruptive CDS, this case report demonstrates that developing a population-based CDS in the patient list column that provides an additional desired functionality to clinicians may result in improved adoption of CDS.

Keywords

clinical decision support - alert fatigue - noninterruptive alerts - neonatology - intensive care

Protection of Human Subjects

The University of Iowa IRB determined this project to be non–human subject research.

Publication History

Received: 25 January 2024

Accepted: 18 August 2024

Accepted Manuscript online:
20 August 2024

Article published online:
13 November 2024

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