Author ORCID Identifier

Date of Award

Spring 3-12-2019

Degree Type


Degree Name

Doctor of Nursing Practice (DNP)



First Advisor

Kimberly Hires, PhD

Second Advisor

Charles Jenkins, DNP



Background: Heart failure (HF) is a progressive disorder which results in poor patient outcomes for those affected. Although there are evidence-based medications to alter the progression and improve outcomes, provider adherence to these medications has been suboptimal. Clinical decision support tools (CDS) within the electronic medical record are effective tools in medical management.

Objective: The primary objective was to evaluate the use of CDS to nurse practitioners (NPs) adherence of guideline-directed medical therapy in HF patients in the outpatient setting. The secondary objective was to assess the NPs perception of facilitators and barriers that may affect the use of CDS.

Methods: A retrospective chart review was performed to extract HF measures and preventative care processes documented during an 18-month period by two NPs at two local primary care clinics in Southeast U.S. Descriptive analysis of the chart data was performed to compare the results of the Centers for Medicare and Medicaid (CMS) National performance quality indicators. Additional data was obtained from questionnaires that assess NPs perceptions and factors that affect the use of CDS.

Results: Collectively, the NPs performance fell below CMS results. However, one NP exceeded CMS indicators in all areas except blood pressure control. Although the NPs had some knowledge of CDS, CDS was not used with each patient contact. The satisfaction of CDS among the NPs was mixed.

Conclusion: CDS use was not verified as a driving factor to the low-performance results as the use of CDS among the NPs was low. Initiation or adjustment of HF therapy by the NPs could not be verified within this QIP. Provider education of GDMT and CDS is key to improving HF outcomes. Further research using pre- and post-intervention analysis is warranted.


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