LAUSR

Critical Care Medicine • Volume 46 • Number 1 (Supplement) www.ccmjournal.org Learning Objectives: Clinical practice guidelines (CPGs) are essential for standardized evidencebased practice, improved outcomes, cost reduction, and compliance with national safety standards. The number of CPGs and utilization format vary widely across critical care settings. Innovative IT systems that integrate 100s of CPGs within the electronic health record are available today. Despite rise in adoption, the value of these systems to nursing care is unknown. At our ICUs, inappropriate use of the system was noted and reasons were investigated by assessing nurses’ perceptions of system usability. Methods: A CPGs-based care plan system was integrated into our nursing documentation system 5 years ago to provide nurses point-of-care access to recommendations for assessment, planning, interventions, and evaluation. We invited 100 nurses from 4 adult ICUs to respond to a usability survey with 37 5-point-rateditems and open-ended questions for advantages and negative aspects of the system. Results: Nurses’ perceptions (N = 100) were favorable on only 12 out of 37 features of the system. Satisfaction with the system was not correlated with years of experience (p> .05). Negative aspects were reported by 90 nurses and were related to lack of communication across CPGs, specifically when more than one CPG and many problems were selected for the patient condition. This resulted in repetitive, tedious, and time consuming documentation, less time spent with patients, and unsafe workaround (i.e., using the system at the end of the shift for documentation to cover nurses legally instead of using the system to guide nursing care). Other negative aspects were difficulty finding appropriate CPGs, lack of safety features, missing/irrelevant information, and lack of perceived system value on patient outcomes. The system lacked value among expert nurses, indicating differences in information need and decision-making process between novice and expert ICU nurses. Conclusions: For proper and safe use, CPGs-based care plan systems should be easy to navigate, support efficient documentation, and present relevant and easy to find information.