Development and evaluation of a clinical decision support system in pressure injury risk management in an intensive care unit: a mixed methods study

This study was conducted using a mixed methods design to investigate the effect of the clinical decision support system for pressure injury risk management in the intensive care unit. Nine clinical nurses in the Anesthesiology and Reanimation Intensive Care Unit of Hacettepe University Adult Hospital participated in the study. Data were collected using the "Pressure Injury Preventive Practices Observation Form," "Pressure Injury Incidence Tracking Form," and "Semi-Structured Interview Guide for Individual Face-to-Face Interviews." In the pretest of the study, no intervention was applied to the nurses; in the posttest-1, the intervention was applied without a clinical decision support system activation (E-BRY), while in the posttest-2, the clinical decision support system was activated (KKDS-BRY). Fisher's exact test was used to compare the number and frequency of preventive nursing practices for the pressure injury risk and the incidence of hospital-acquired pressure injury between the pretest, posttest-1, and posttest-2 measurements of the study. As a result of the analysis, no difference was found between the pretest, post-test-1, and post-test-2 measurements of the study in terms of the pressure injury incidence (p>0.05). The intervention without a clinical decision support system, corresponding to the post-test-1 measurement of the study, increased intensive care nurses' re-positioning practices, assessment of nutrition-related laboratory findings, skin color, increased skin moisture, and skin integrity assessment (p<0.05). However, the activation of the clinical decision support system did not lead to an increase in nurses' pressure injury preventive practices. Considering the user experiences of the intervention, it is recommended to evaluate the effect of the intervention on pressure injury risk management after at least six months of use by minimizing the conditions that negatively affect the use of the intervention, particularly the lower compliance of the user. Keywords: Pressure ulcer; decision support systems, clinical; critical care; risk management.