Introduction of Computerized Physician Order Entry to Reduce Prescribing Errors - Research Proposal Example

Introduction of Computerized Physician Order Entry to Reduce Prescribing Errors Name: Institutional Affiliation: Table of Contents Introduction 2 Identification and Substantiation 3 Aim of Change Innovation 5 Change Strategy 6 Understanding Lewin’s Model 7 Unfreeze 7 Change 8 Refreeze 8 Business Plan and Budget 9 Planning 10 Implementation 11 Evaluation 12 Dissemination 12 Conclusion 13 References 14 Appendices 16 Introduction Medication is the most common health therapies, in Australia and other continents of the world. Research shows that in any two-week time period, about 7 to 10 Australians will have taken medicine (Roughead, Semple, & Rosenfeld, 2013). The figure further increased, especially for the older population and that about 9 to 10 elderly individuals will have taken medication in any two-week period (Roughead, Semple, & Rosenfeld, 2013). These statistics show how often human beings depend on medicine. Because of this, proper prescription is crucial in ensuring that the country has a healthy population. It is important to realize that medicines can cause harm. However, this can be prevented through the proper prescription of medication to patients. The Computerized Physician Order Entry refers the process of electronic entry of the medical practitioner’s instructions so as to treat patients under his or her care effectively (FCG, 2003). The Computerized Physician Order entry (CPOE) has numerous advantages. Some of these advantages include; reduction of errors associated with transcription or handwriting, significantly reducing delay in order completion, provision of errors associated with duplication or incorrect test or doses and also simplifying posting and inventory charges (Steele & DeBrow, 2010). The main aim of this report is to determine and validate the need and importance of the Computerized Physician Order Entry in reducing prescribing errors. The report will analyze relevant literature other studies that have sought to identify; the impact CPOE has on reducing errors. The paper will be organized into three main sections; Identification and Substantiation, development of an appropriate change strategy and the business plan and budget section. Identification and Substantiation Prescribing errors vary from errors that may cause harm to the patients, to the errors that cause administration of the wrong therapy with or without any harm. The errors may also include; the documentation errors that are commonly referred to as procedural errors. For example, situations where the prescription is unclear, missing signature and non-documentation of the administration route. A study carried out in Australia showed that an estimated that prescribed errors amounted to about 2.5% of the total prescription. Other studies have put the error rates from 5% to 11% of the medicine orders (Roughead, Semple, & Rosenfeld, 2013). From 2006 to 2007 a direct observational study to determine administration was carried out across 6 surgical or medical wards in two main New South Wales’ teaching hospitals. During the study, 98 nurses who administered 4271 medicines to about 720 adults were observed (Roughead, Semple, & Rosenfeld, 2013). The observation was afterward compared with the hospitals’ medication charts so as to identify any errors. The main observers were registered physician and nurses (Roughead, Semple, & Rosenfeld, 2013). In an attempt to avoid any form of biases, the comparison between the medicine charts and observation were undertaken by independent clinical pharmacist and nurse. The errors were later classified into two, these included procedural errors such as failure to check the patient’s identification and the clinical errors such as wrong medicine administered (Roughead, Semple, & Rosenfeld, 2013). The errors were further rated according to their actual severity of the specific patients. The results were shocking, and it was determined that 80% of the medicine administrations were mainly associated with either clinical or procedural. Out of the 80%, errors, 25% were associated with clinical errors and 74% associated with procedural errors (Roughead, Semple, & Rosenfeld, 2013). These studies portray the extent in which the medical practitioner tends to make several prescription errors and that most of them go un-noticed. Another study was carried out in Queensland between 2008 and 2009 to determine the number of prescription errors being made by the medical practitioners. What was unique about this study is that the researchers used a retrospective chart review so as to be able to determine the medicine omission rate. The study involved 288 adult individuals who were at one point or another prescribed at least regular medicines and admitted to any of the medical wards in a Queensland hospital (Roughead, Semple, & Rosenfeld, 2013). During the study, there were about 15,020 administration episodes where 11% were deemed to be medicine omissions (Roughead, Semple, & Rosenfeld, 2013). On the other hand, about 76% percent of the observed patients experienced an omission. It was further discovered that there was an average of about 5.8 omissions per a single patient (Roughead, Semple, & Rosenfeld, 2013). These studies are proof for the need for an effective system that would ensure that all the patients receive the best treatments [Orm05]. This will play a significant role towards reducing medical related admission in Australia. The current figures put medical related admissions be between 2% to 3% of the total admissions in Australia (Duguid, 2009). This is a significant number considering such issues can be avoided through systems such as Computerized Physician Order Entry. The statistics further show that this equates to about 190,000 hospital admissions in Australia. About 50% of the cases are preventable and that 30% of the 190,000 are patients over 75 years (Duguid, 2009). Aim of Change Innovation The complexities associated with medication administration and management tend to pose a vital risk to the hospitalized patients. Each phase of the entire medication process such as; prescribing, administering, dispensing and even monitoring, tend to provide opportunities for an error or confusion (Reckmann, Westbrook, & Day, 2009). Several studies have revealed adverse drug events commonly referred to as ADE’s which are preventable, to be a common occurrence to most of the inpatients in Australia (Doolan & Bates, 2002). This prevalence has been identified to occur during the ordering and prescribing stage. The CPOE has been continuously identified as a significant intervention and with the potential to reduce most forms of prescribing errors that in turn causes injuries to the patients (Reckmann, Westbrook, & Day, 2009). The CPOE achieves this by automating the medication ordering process and thus even those without any decision support may have significant advantages over the hand-written prescriptions in relation to the level of standardization, the use of approved names and the storage and recall of the records (Reckmann, Westbrook, & Day, 2009). The CPOE system is further improved by the incorporation of the Clinical Decision Support System commonly referred to as the CDSS which are of varied sophistication so as to assist in functions such as doses in renal failure, adherence to the prescribing guidelines and the identification of any duplicate therapy or drug interactions (Roughead, Semple, & Rosenfeld, 2013). Several studies have further shown that the electronic prescribing, facilitated by CPOE plays a significant role in increasing the prescribing quality in various hospitals (Steele & DeBrow, 2010). Internationally, health systems are making huge investment in the CPOE systems. This is because most of them have realized the importance of the facility in facilitating effective treatment [CMS12]. It is important that most of the hospitals in Australia incorporate the same systems so as to ensure the huge error in prescribing medication goes down significantly. It is important to note that this could be easily achieved if the system is properly implemented. Change Strategy Change can occur in all types of business regardless of the industry, size and age of the business. The concept of change management is a familiar concept in most of the organizations today. However, what is important is how the organizations manage. Change varies significantly mainly depending on the nature of the organization, the people and the change that is required. Understanding Lewin’s Model Lewin attributes change in organizations to a cube of ice that has to undergo three main stages. These involve unfreezing which involves melting the ice, molding then refreezing the ice (NHS North West, N.D). The molding process is highly likened to the change that the organizations experience. So as to be successful in the process of change one must understand the need for change (Lewin's Change Management Model, 2014). In this case, the team medical practitioner should understand why it is important for the organization to shift to the Computerized Physician Order Entry. Unfreeze This is the first stage in Lewin’s Model for change and that this stage mainly involves preparing the organization or institution to accept that change is necessary (Petrescu, 2011). This will mainly involve setting up a meeting and explaining to the staff the reasons as to why the hospital has to start using the CPOE [Dav04]. To change the organization successfully, Lewin states that one needs to start with its core. This is achieved by changing the values, attitudes, beliefs and behaviors that presently define the organization (Kritsonis, 2005). This can only be achieved if there is support from the executive management. This therefore means that the top level management should be convinced on the need of incorporating CPOE in the hospital so as to easily pass the same idea of change to the other staff members. Without the support of the executive management team, then the process of change is likely to fail in any organization (Schein, 1995). Change This is the second stage, and this mainly involves communicating more often to the individuals about the change (Bashar & Barakat, 2013). This stage further requires communicating the advantages associated with the CPOE. Some of the main advantages include; simplifying the posting and inventory charges, reducing error that relates to transcription or handwriting, reducing delay in order completion and provision of error checking in case of duplicate or incorrect tests or doses. It is also important that the initiator of the project and his or her team avail time to answer some of the questions that the members of the organization might be having towards the planned change. Most of these questions are mainly related to the rumors that people associate with the change. Proper clarification goes a long way in enabling the staff members accept change (Kritsonis, 2005). The other way in which the change can be effected is through encouraging participation among the members of the organization since this provides a platform for them to get first-hand experience on what the change will entail [AHR14]. Refreeze One of the main signs that determine whether an organization is ready to refreeze include; signs such as consistent job description, organizational chart and coherent working relationship among the employees themselves (Gallos, 2006). Under this stage, it is important to anchor the change in the organization’s culture. This will involve ensuring that all the medical practitioners in the institution embrace the use CPOE in prescribing to a patient and not using the traditional methods (AHRQ, 2014). This will further be enhanced by identifying the factors that support this kind of change. It is also important to identify the barriers so as to strengthen on the weaknesses and ensure the success on the process of change (Ohsfeldt & Ward, 2005). Business Plan and Budget This specific business plan will be implemented in 3 main stages; these will include; the planning stage, implementation and the evaluation stage. All these stages are crucial in ensuring the success of the entire project. The main source of funds of the project will be the hospital administration considering this is a developmental project, aimed at improving the services that a specific hospital offers. So as to ensure approval of the funding, effective collaboration will be required between the project manager and the management of the hospital [Fel13]. This will provide the top level management an opportunity to effective understand the main functions the CPOE will be carrying out and how it will be able to play as significant role in reducing prescribing errors [Kot92]. Staff education is very crucial part in this process and very costly at the same time. However, for the project to succeed, it is important for the team of staff to be effectively trained and equipped to handle the CPOE system [Fel13]. As discussed above, it was identified that most of the staff gave out wrong prescription to patients and this caused a lot of harm to patients. To prevent the same mistakes from being carried forward it is important for the team of staff to under proper training. Under this section we will carry out an analysis and estimate the average cost of the entire project. The cost of implementation of the CPOE to vary with the location of the hospital. One cannot expect the cost of implementation in a rural area be the same as the cost of implementation in an urban area [Ohs05]. This study incorporates all these aspects. From the analysis and estimation of costs, it is right to imply that the minimum, implementation cost of this project would cost from a minimum of 1.3 million for the rural based hospitals to up to a maximum 4.3 million for it to be implemented in urban hospitals. There exist certain urban hospital that would carry out the same implementation at a cost of 2.1 million dollars [Ohs05]. A critical analysis shows that, for the critical access the implementation could be around 18% of the organizations operating cost under the low cost option and over 29% [Ohs05]. Planning As stated above, all these stages are very crucial in ensuring the success of the project and that this can only be achieved when there is effective cooperation from both sides. It is important to understand how long the entire implementation process will take and the amount of resources that will be required [Min14]. This will involve the purchase of other machineries and training of the staff so as to enable them operate the equipment effectively. This will also require cooperation among the other staff member and should understand the serious of the project. The project will require the use of applications such as Cisco, TBD, Meditech PCM, Meditech EMR, Meditech POM, forward advantage and Citrix [Fel13]. Most of the staff member are not familiar with such processes and thus will have to be trained on the same. The management of the hospital in collaboration with the Project manager should formulate the best schedule that will facilitate training and at the same time not affecting their work schedule and performance. As stated above, a huge significant of funds were allocated for the training of the staff member and it is therefore right to incorporate the staff in the planning process. It is important for the staff members actively involved and this will involve being there from the initial process to the point where there is full understanding and incorporation of the system into the organization [Rec09]. This project will be headed by the main sponsors of the project who is mainly the head of the hospital and the team of top medical nurses and physicians in the hospital. This sort of management will ensure that change is influenced across the various department of the organization thus facilitating the ease in which the CPOE will be able to gain acceptability [Kri05]. Leadership is crucial factor in any project. For any project to succeed the leader or leaders of the project should be able to rally with the project and thus enable it achieve its main objectives [FCG03]. It is therefore important for the team of the physician and nurses to ensure that all the requirements are effectively implemented. Implementation Being a major project, its implementation is expected to consume a lot of funds and at the same time consume a lot of time. The entire implementation process is expected to last for almost four years. This is because of the nature of the project and the fact that if hurriedly implemented it could cost a lot lives. This, will therefore require patience from all the stakeholders. Some of the initial projects to be implemented in the first one and half years include; Patient lists, face sheets, Lab radiology results, remote access, online medical records transcription, wireless guest network and selective auto-faxing [Ohs05]. These projects can easily be implemented. Periodic assessment shall be carried out to determine the progress made, search for any weaknesses and also major on the strengths identified. As shown in appendix A the implementation will be in two main phases, that will last four years and that the 4 years will be divided into 4 quarters a year. This specific strategy will ensure effective implementation is achieved in the process. It is expected that the staff and the patients will enjoy start enjoying the benefits of the CPOE immediately the first phase of implementation is completed. The other phase will be achieved before the end of the set four year time frame. This other phase will involve projects such as electronic signatures, automated alerts via pager, film radiology, physician office integration interfaces and PCM physician documentation among other projects [FCG03]. Evaluation Project evaluation is very important in ensuring that the main goals are achieved. Evaluation should be carried out continuously so as to identify the strength and weaknesses of any project. Upon identification of any form of weakness, the project manager will and the implementation team will be charged with the responsibility to identify the origin of the weaknesses and how to solve them. If some of the weakness are not well taken care of, this may have a long term effect of jeopardizing the whole project. Some of these weaknesses may even include; staff not understanding, how to operate the machines effectively. Evaluation can be carried through surveys at the organization so as to get to know how the staff feels about the entire process and the impact it has had on their job and lives [AHR14]. Dissemination The staff members should be communicated to from time to time and explain to them some of the main changes that have occurred and the need for those specific changes. This is also important so as to inform them on the progress they have made and how it has impacted the organization. The methods of communication can be in so many ways, this can be via meetings, emails or even posting the result on various notice within the organization [Ohs05]. The first stage of disseminating information will involve conveying the message, through a formal presentation during a meeting with the top management and other stakeholders of the business. It is important that they are aware of the change that is to occur and that they be informed on the steps that will be involved in the entire project. The other senior individuals such as physiotherapist, wards person and intensive care persons, the information will be communicated to them within the first week of the project. Practical examples will be very crucial at this stage and therefore will be carried out on specific schedules. There results of the progress made ever two week will regularly posted on the information centers of the business so as to enable the staff identify themselves with the progress that they have achieved [Fel13]. Conclusion The CPOE will have a significant impact in reducing prescribing errors in various hospitals across Australia. However, this can only be achieved if the project is effectively implemented to ensure that the patients’ welfare are well taken care off. I strongly believe that if the procedures stipulated above are strongly followed then the project will be a great success, and this will go a long way in improving and saving the lives of most patients in Australia. Doctors and nurses should take this initiative positively and ensure that they play their role in ensuring the success of the project. After successive implementation of the whole process, we expect the number of prescribing errors to go down significant and that also the number of patients admitted due prescribing errors to reduce. References Orm05: , (Ormond, 2005), CMS12: , (Creswick, et al., 2012), Dav04: , (Davidson & Riordan, 2004), AHR14: , (AHRQ, 2014), Fel13: , (Felt, 2013), Kot92: , (Kotter, 1992), Ohs05: , (Ohsfeldt & Ward, 2005), Min14: , (Mind Tools Ltd, 2014), Rec09: , (Reckmann, Westbrook, & Day, 2009), Kri05: , (Kritsonis, 2005), FCG03: , (FCG, 2003), Appendices Appendix A N/B Q1 – Q4 represents a whole year. Read More