Development and application of an evidence-based clinical decision support system for venous thromboembolism prophylaxis and nursing care

Objectives: To develop an evidence-based clinical decision support system (CDSS) for venous thromboembolism (VTE) prophylaxis and nursing care, and to evaluate its effectiveness in clinical practice. Methods: An evidence-based knowledge base for VTE prevention and nursing care was first established through a systematic literature review and the Delphi method. Subsequently, an evidence-based CDSS was developed following a 6-step waterfall development model and refined following a 4-week pilot implementation. A single-center, historical control quasi-experimental study was conducted in 11 clinical departments of a tertiary hospital in Xiamen. Eligible participants included inpatients hospitalized for at least 3 days (excluding those with preexisting VTE or early discharge) and registered nurses with at least 1 year of clinical experience (excluding those on long-term leave or not involved in CDSS operation). The preintervention group (June 2024–November 2024) received standard VTE care, while the intervention group (January 2025–June 2025) implemented the CDSS after nurses completed standardized training. Outcome measures included the incidence of in-hospital VTE, compliance rate with VTE nursing quality standards, and nurses’ user experience (assessed using the Clinical Nursing Information System Effectiveness Evaluation Scale). Statistical analyses were performed using SPSS version 23.0, applying the χ2 test, t est, and nonparametric tests as appropriate; a P -value <0.05 was considered statistically significant. Results: After CDSS implementation, the incidence of in-hospital VTE decreased from 0.17% (20/11610) to 0.11% (12/10965). The postimplementation compliance rate with VTE nursing quality standards was 81.64%, significantly higher than the preimplementation rate of 31.19% ( P < 0.05). A survey of 361 nurses from the 11 departments who used the system indicated positive user experiences and high overall satisfaction with the system. Conclusion: This study developed an evidence-based CDSS for VTE prophylaxis and care, integrating inline interoperability, alert mechanisms, automated VTE risk assessment, intelligent recommendations, automated matching of nursing interventions, and closed-loop-style management. The CDSS was effective in improving compliance with VTE nursing quality standards, promoting the implementation of prevention and treatment measures, reducing the incidence of in-hospital VTE, and enhancing nurses’ satisfaction with the system.