Development of a clinical decision support system in intensive care unit for pressure injuries management: a study in developing country

Clinical Decision Support Systems (CDSS) have become essential tools in healthcare, particularly since the late 20th century. These systems are designed to enhance evidence-based practice, ensure adherence to care standards, and improve the quality and safety of clinical interventions. In the context of pressure injuries management, CDSS utilize patient-specific data to provide tailored recommendations, alerts, and reminders aimed at prevention. The purpose of this study is to develop a CDSS for pressure injuries management in Itensive Care Unit (ICU).

This study was conducted from 2022 to 2023. A questionnaire was designed to identify critical data elements and system requirements, with its reliability subsequently validated. ICU professionals, particularly nurses, assessed the importance of each item using a 5-point Likert scale. Based on this feedback, a web-based platform featuring the user interface and system prototype was developed. Following a three-month pilot implementation, system usability was evaluated using the System Usability Scale (SUS) questionnaire.

ICU healthcare professionals identified essential elements, which were grouped into five categories deemed essential for the CDSS in pressure injuries management. Based on this feedback, a conceptual model and graphical interfaces were designed through Unified Modeling Language (UML) diagrams and prototypes, and a web-based system was subsequently developed using PHP and MySQL. Evaluation results demonstrated high usability and positive user satisfaction.

Unlike existing CDSSs such as PURPOSE T and Waterlow-based systems, which primarily standardize risk assessment, our system is tailored for ICUs in resource-limited settings by mandating structured electronic documentation, automating Braden Score scoring, and providing real-time alerts for high-risk patients. Additionally, features such as QR-based bedside access and integration with local workflows highlight its adaptability and practical innovation for developing country contexts.