Acceptance of clinical decision support system to prevent venous thromboembolism among nurses: an extension of the UTAUT model.

BACKGROUND: Venous thromboembolism has been a major public health problem and caused a heavy disease burden. Venous thromboembolism clinical decision support system was proved to have a positive influence on the prevention and management of venous thromboembolism. As the direct users, nurses' acceptance of this system is of great importance to support the successful implementation of it. However, there are few relevant studies to investigate nurses' acceptance and the associated factors are still unclear. OBJECTIVE: To investigate the determinant factors of nurses' acceptance of venous thromboembolism clinical decision support system with the modified Unified Theory of Acceptance and Use of Technology. METHODS: We designed a questionnaire based on the modified Unified Theory of Acceptance and Use of Technology and then a cross-sectional survey was conducted among nurses in a tertiary hospital in Nanjing, China. Statistically, a Structural Equation Modeling -Partial Least Squares path modeling approach was applied to examine the research model. RESULTS: A total of 1100 valid questionnaires were recycled. The modified model explained 74.7%, 83.0% and 86% of the variance in user satisfaction, behavioral intention and user behavior, respectively. The results showed that performance expectancy (ß = 0.254, p = 0.000), social influence (ß = 0.136, p = 0.047), facilitating conditions (ß = 0.245, p = 0.000), self-efficacy (ß = 0.121, p = 0.048) and user satisfaction (ß = 0.193, p = 0.001) all had significant effects on nurses' intention. Although effort expectancy (ß = 0.010, p = 0.785) did not have a direct effect on nurses' intention, it could indirectly influence nurses' intention with user satisfaction as the mediator (ß = 0.296, p = 0.000). User behavior was significantly predicted by facilitating conditions (ß = 0.298, p = 0.000) and user intention (ß = 0.654, p = 0.001). CONCLUSION: The research enhances our understanding of the determinants of nurses' acceptance of venous thromboembolism clinical decision support system. Among these factors, performance expectancy was considered as the top priority. It highlights the importance of optimizing system performance to fit the users' needs. Generally, the findings in our research provide clinical technology designers and administrators with valuable information to better meet users' requirements and promote the implementation of venous thromboembolism clinical decision support system.

Evidence-based summary for the safety of multiple medication in elderly patients with ischemic stroke.

Background: To retrieve, analyze, and summarize the relevant evidence of home-based medications use for stroke patients, so as to provide evidence for safe home-based medication of elderly patients with ischemic stroke. Methods: We performed a search in the databases of British Medical Journal (BMJ) Best Practice, UpToDate, Joanna Briggs Institute (JBI) Evidence-based Health Care Center Library, Cochrane Library, PubMed, China National Knowledge Infrastructure (CNKI), Wanfang Knowledge Data Service Platform, and others, according to the evidence pyramid model. We retrieved all evidence on the safety of home-based multiple medications use in elderly patients with ischemic stroke, including clinical decision-making, expert consensus, guidelines, systematic reviews, and summary of evidence. The search time limit was from the establishment of the database to March 2021. The literature evaluation standard and evidence grading system of JBI Evidence-based Health Care Center were used to evaluate the quality of the literature, and to classify the extracted evidence. Results: A total of 17 articles were included in this study, comprising 2 guidelines, 11 systematic reviews, 3 evidence summaries, and 1 expert consensus. This article summarizes the 7 best evidences from 5 aspects: drug dispensing, drug identification, medication time, prescription simplification, and self-management plan. Conclusions: The evidence of home-based multiple medication use in elderly patients with ischemic stroke provides an evidence-based reference for ensuring the safety of medications for patients, and guides elderly patients with ischemic stroke and their caregivers by applying the best available evidence.