Post on 17-Dec-2015
Presented by Renae Foor
1. Define Computerized Physician Order Entry System
2. Describe hardware/software3. Review the information system4. Assess nursing implications5. Examine related legal/ethical issues6. Advantages/Disadvantages from nursing
perspective
What is
CPOE?
Computer
Physician Order
Entry is software
that allows
physicians to
directly enter
their medical
orders into a
hospital
information
system.
(Reider,
2003)
Medical orders include…MedicationLaboratory testsRadiological proceduresSurgical proceduresDietary orders
Offers access to patient records
Offers clinical decision support
Eliminates illegible handwriting
Real-time access to patient records
Offers clinical decision support
Avoids transcription errors
Speeds up response timeImproves accuracy and
completeness
(Zahn, Hicks, et al., 2006)
From a desktop computer
From a personal data assistant
From other electronic devices
(Zahn, Hicks, et al., 2006)
Lightweight, hand-held computer used as an information organizer and has communication abilities.
Keyboard or pen-basedApplications
a) Word processorb) Spreadsheetc) Calendard) Address book
Sends and receivesa) Faxesb) Datac) E-mail messages
ComputerMachine that stores and manipulates data and programs.
• Hardware – physical body
• Software – application programs
a) Word processingb) Spreadsheetsc) E-maild) Internete) Conferencing (McGonigle &
Mastrian, 2009)
The information,
such as physician
orders or test
results, is initially
entered into the
hospital database
where it is easily
accessed by
different
specialized
departments.
(Reider,
2003)
How the System Works?
Easily AccessibleChannels user through
a series of questionsUnproblematic for
experienced and inexperienced nurses
Tasks are completed with accuracy
Tasks are completed quickly
(Staggers, 2003)
CPOE systems must intersect with HIS systems like:
McKesson HISa. Booking & pre-admissionb. Admission & registrationc. Bed assignment, transfer, & discharged. Charging & claim submissione. Management & follow-upf. Customer service
(McKesson,
2008)
Allow professionals’ entry and access to data in real time to enhance quality of patient care
User involvement in all steps of the implementation of design and evaluation
Value of issues such as culture, advancement, and leadership for successful implementation
(Oroviogoicoechea, Elliot, & Watson, 2008)
Legal IssuesI. Physicians coercing nurses to
enter orders for them
II. Physicians leaving the floor to call in telephone orders
III. Patient privacy and security
IV. Physician overrides/Medical malpractice
V. Poor implementation
VI. Improper Use
VII. Deficient ergonomics
Exceptions to CPOE
1. Phone orders if no computer access
2. Emergency orders3. Protocol orders4. Verbal orders given during
procedures5. Orders during computer
system downtime
Advantages of CPOE1. Provides drug screening information2. Helps prevent adverse drug effects3. Improves quality of patient care4. Reduces drug expenses5. Provides predefined orders6. Speeds up medication ordering7. Easy accessibility to patient’s medical
orders8. Eliminates handwriting/transcription
errors9. Increases productivity and workflow10.Provides decision support
Disadvantages of CPOE1. Too much information/over-alerting2. Physician non-acceptance3. Integration/staff training4. Installation costs5. Intrusion of physician decision-
making
Nursing CompetenciesNurses utilizing CPOE will need to:a. Use the database applications to enter and
retrieve patient data/ordersb. Demonstrate basic technology skills (typing
& printing)c. Use applications for structured data entry d. Use the application to plan care for patientse. Use networks to navigate systemsf. Operate peripheral devices (PDAs)
Nursing Functions/Responsibilities1. Enter admission/discharge
orders2. Place medication and non-
medication orders3. Place ordersets4. Update allergy information5. Resolve orders conflicts6. Discontinue orders
To Review……..CPOE:1) Offers quick access to patient medication
orders2) Offers clinical decision support3) Provides drug screening information4) Helps prevent adverse drug effects5) Improves quality of patient care6) Allows real-time access to patient records7) Improves accuracy and completeness of
physician orders
ReferencesMcGonigle, D. & Mastrian, K. ( 2009). Nursing informatics and the
foundation of knowledge. Boston: Jones & Bartlett Publishers.
McKesson. (2007). HealthQuest, Retrieved December 14, 2008 from http://www.mckesson.com/en_us/McKesson.com/For+Healthcare+Providers/Hospitals
Oroviogoicoechea, C., Elliott, B., & Watson, R. (2008). Review: Evaluating Information Systems in Nursing. Journal of Clinical Nursing 17, 567-575.
Reider, J. (2003). Computerized Physician Order Entry: Has the Time Come? Medscape General Medicine, 5(2).
Stagger, N. (2003). Human Factors: Imperative Concepts for Critical
Care. AACN Clinical Issues, 14(3), 310-319. Zahn, C., Hicks, R.W., Blanchette, C.M., Keyes, M.A., & Cousins, D.D.
(2006). Potential Benefits and Problems With Computerized Prescriber. American Journal of Health System-Pharmacy, 63(4), 353-358.