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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. OBJECTIVE: To enhance a poorly functioning interruptive alert by converting it to a non-interruptive 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 non-interruptive patient column clinical decision support (CDS) tool was created to replace an interruptive alert. A pre-post intervention mixed-methods cohort study was conducted between January 2022 - 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 hours to 30.7 hours (p = 0.02). There was universal adoption of the CDS tool, and clinicians no longer used the manual patient list. CONCLUSIONS: While previous studies have reported that non-interruptive 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.
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Problem: Newborn admission to the neonatal intensive care unit (NICU) is stressful. Yet in clinical practice, at best, NICU mothers are screened for depression and if indicated, referred to a mental-health specialist. At worst, no action is taken. Listening Visits, an empirically supported nurse-delivered intervention addressing emotional distress, can be conveniently provided by a NICU nurse. Prompted by the need to minimize face-to-face contacts during the pandemic, the primary purpose of this small pilot trial was to assess the feasibility of having nurses provide Listening Visits to NICU mothers over Zoom. Secondarily, we assessed pre-to post-Listening Visits depression symptom scores as a preliminary evaluation of the effectiveness of this type of support. Materials and methods: Nine NICU mothers with mildly to moderately severe depression symptoms received up to six Listening Visits sessions from a NICU nurse via Zoom. Participants completed the Inventory Depression and Anxiety Symptoms-General Depression scale (IDAS-GD) at study entry and 4- and 8-weeks post enrollment. They completed the Client Satisfaction Questionnaire (CSQ) at the 8-week assessment. Results: Using an intent-to-treat approach, the effect of time from the mixed model analysis of IDAS-GD was statistically significant (F(2,26) = 10.50, p < 0.001), indicating improvement in IDAS-GD scores from baseline to follow-up. The average CSQ score was high (M = 29.0, SD = 3.3), with 75% of participants rating the quality of help they received as "excellent". Discussion: In this pilot trial, we learned it is feasible to provide Listening Visits over Zoom, that this mode of delivery is associated with a significant decrease in depression symptom scores, and that women value this approach. Clinical trial registration: [https://clinicaltrials.gov/], identifier [#201805961].
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Moving novel, evidence-based interventions into broad community use is challenging. This column describes how a midlevel public health administrator acted in the role of broker to link university-based researchers with maternal health clinical staff to successfully implement an innovative, evidence-based maternal depression treatment. Program evaluation assessed adoption, implementation, reach, and effectiveness. In reflecting on this partnership, the broker provided critical elements of access, credibility, and accountability. A partnership between service providers and research teams provides one strategy to disseminate evidence-based practices among those served by public-health programs.