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Abstract: Purpose: The purpose of the study was to measure the effect of a computerized decision support system (CDSS) on adherence to tidal volume (V T) recommendations. Materials and Methods: We performed a prospective before-after evaluation study on applied V T to examine the impact of a CDSS on adherence to our local protocol in a 30-bed mixed medical-surgical intensive care unit of a university hospital. All intensive care unit patients who were intubated and mechanically ventilated for at least 1 hour were included. Results: A total of 3 663 674 V T records of 696 patients were analyzed. The average volume greater than 6 mL/kg predicted body weight (PBW) and the mean percentage of ventilation time with V T greater than 6 mL/kg PBW decreased after intervention by 6.0% and 3.4%, respectively (not significant). A stronger effect of the decision support intervention was found among patients with longer duration of mechanical ventilation (>24 hours): for these patients, the average V T in exceeding 6 mL/kg PBW and the mean percentage of ventilation time with V T greater than 6 mL/kg PBW decreased after intervention by 18.3% (P = .01) and 9.5% (P = .01), respectively. In this group, the mean percentage of ventilation time with V T records between 8 and 10, between 10 and 12, and greater than 12 mL/kg PBW decreased by 21.8% (P = .006), 21.5% (P = .047), and 24.7% (P = .155), respectively. Conclusions: The use of a CDSS, integrated in a patient data management system, improves implementation of a lower V T mechanical ventilation strategy for patients ventilated for longer than 24 hours. [Copyright &y& Elsevier]

Purpose: Drug-drug interactions (DDIs) may cause adverse outcomes in patients admitted to the Intensive Care Unit (ICU). Computerized decision support systems (CDSSs) may help prevent DDIs by timely showing relevant warning alerts, but knowledge on which DDIs are clinically relevant in the ICU setting is limited. Therefore, the purpose of this study was to identify DDIs relevant for the ICU., Materials and Methods: We conducted a modified Delphi procedure with a Dutch multidisciplinary expert panel consisting of intensivists and hospital pharmacists to assess the clinical relevance of DDIs for the ICU. The procedure consisted of two rounds, each included a questionnaire followed by a live consensus meeting., Results: In total the clinical relevance of 148 DDIs was assessed, of which agreement regarding the relevance was reached for 139 DDIs (94%). Of these 139 DDIs, 53 (38%) were considered not clinically relevant for the ICU setting., Conclusions: A list of clinically relevant DDIs for the ICU setting was established on a national level. The clinical value of CDSSs for medication safety could be improved by focusing on the identified clinically relevant DDIs, thereby avoiding alert fatigue., Competing Interests: Declaration of Competing Interest All authors declare that they have no competing interests., (Copyright © 2020 The Authors. Published by Elsevier Inc. All rights reserved.)

Abstract: Purpose: Our hypothesis was that both styles are effective to decrease tidal volume (VT) but that critiquing comprises the most effective strategy. The purpose of this study is to test this hypothesis by measuring the effect of an active computerized decision support system, in 2 communication styles, consulting and critiquing, on adherence to VT recommendations. Materials and Methods: We developed and implemented an active computerized decision support system (CDSS) working in a consulting style that always shows the preferred VT and in a critiquing style that shows the preferred VT only if VT is above the desired threshold. A prospective, off-on-off-on study evaluated the system''s performance in a mixed medical-surgical intensive care unit of a university hospital. Results: Four thousand seven hundred sixty-four patient-day mechanical ventilation from 757 patients were analyzed. The percentage of ventilation time in excess of 6 and 8 mL/kg predicted body weight decreased significantly after intervening with the consulting style (12% reduction and P < .001; 22% reduction and P < .001) and again increased after stopping the CDSS (11% increase and P < .001; 29% increase and P < .001). With the critiquing CDSS, the percentage of ventilation time in excess of 6 and 8 mL/kg predicted body weight again decreased significantly (6% reduction and P < .001; 15% reduction and P < .001). Conclusions: The use of a CDSS in both communication styles improved the use of lower VTs for ventilated patients. When decision support was not sustained, adherence to low VT fell back to its original value. Interestingly, the consulting style had a slightly larger effect. This may stem from the high frequency of showing reminders in this style and the relatively simple underlying guideline where its display implies the associated action of lowering VT. The consulting style, however, was more interruptive for clinicians, calling upon the need to strike a balance between effect and intrusiveness. [Copyright &y& Elsevier]