title: Cognitive analysis of decision support for antibiotic prescribing at the point of ordering in a neonatal intensive care unit.
abstract: Computerized decision support systems have been used to help ensure safe medication prescribing. However, the acceptance of these types of decision support has been reported to be low. It has been suggested that decreased acceptance may be due to lack of clinical relevance. Additionally, cognitive fit between the user interface and clinical task may impact the response of clinicians as they interact with the system. In order to better understand clinician responses to such decision support, we used cognitive task analysis methods to evaluate clinical alerts for antibiotic prescribing in a neonatal intensive care unit. Two methods were used: 1) a cognitive walkthrough; and 2) usability testing with a 'think-aloud' protocol. Data were analyzed for impact on cognitive effort according to categories of cognitive distance. We found that responses to alerts may be context specific and that lack of screen cues often increases cognitive effort required to use a system.
authors.affiliation: Columbia University School of Nursing, New York, NY, USA.
authors.forename: Barbara
authors.initials: B
authors.lastname: Sheehan
authors.forename: David
authors.initials: D
authors.lastname: Kaufman
authors.forename: Peter
authors.initials: P
authors.lastname: Stetson
authors.forename: Leanne M
authors.initials: LM
authors.lastname: Currie
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D003071:Cognition; D020000:Decision Support Systems, Clinical; D004360:Drug Therapy, Computer-Assisted; D006801:Humans; D007231:Infant, Newborn; D007233:Infant, Postmature; D007235:Infant, Premature, Diseases / Q000188:drug therapy*; D007363:Intensive Care Units, Neonatal; D050316:Medical Order Entry Systems; D013647:Task Performance and Analysis; D014584:User-Computer Interface
chemical_list: D000900:Anti-Bacterial Agents