Implications of Computerized Physician Order Entry Will Have on Nursing - Essay Example

?Running head: Implications of Computerized Physician Order Entry will have on Nursing Insert Insert Insert Aug. 2011 Computerized Physician Order Entry (CPOE) Most people lose their lives due to medical errors in hospitals. However, computerized physician order entry systems provide error prevention despite its high cost. CPOE is a process that entails entering medication orders and physicians’ instructions in a computer, instead of noting down on paper. Therefore, the use of CPOE helps to reduce errors caused by poor handwriting. However, the cost of implementation is feared by many hospitals, making the rate of adoption of the process quite low. According to Bates et al. (1999) errors also result to injury or adverse drug event (ADE), resulting to extra work in the hospital. Surprisingly, some ADEs could result to death, with their costs resulting to approximately $2 billion in hospitals. Computerized order entry assists physicians to write orders online, and it ensures that the orders are eligible, complete, and unambiguous. The use of a computer assists physicians in suggesting the appropriate doses while ordering and displaying the necessary laboratory data. It also assists in screening orders for any allergies. As hospitals continue to seek quality care for their patients, health information technology is mostly used in the reduction of medical errors. CPOE is one of the tools used, with an aim of improving quality and safety in hospitals. Approximately 98,000 errors occur in hospitals each year and they result from poor handwriting and miscommunications among the physicians. Nevertheless, CPOE is a savior in such situations, as it requires the providers to type patient’s orders. The CPOE systems have capabilities of reducing the occurrence of harmful drug interactions. Studies conducted have shown that CPOE have the potential to increase care of patients on monitoring and surveillance basis so as to reduce medication errors (Kazley & Diana, 2011). Implications of Computerized Physician Order Entry on Nursing The American recovery and reinvestment act of 2009 requires hospitals to be meaningful users of health information technology, in which CPOE falls under. According to Fields et al (2009, p840), CPOE are being implemented in hospitals at an increasing rate, however, nurses and nursing work is affected by CPOE in one way or another. In a study conducted by Fields et al (2009, p.840), at the community hospital in southern California where nurses were interviewed on the aspects of CPOE and its effects on the nursing, the nurses’ responses viewed CPOE as a successful tool as it allowed them to be more intelligent when taking care of patients. The nurses viewed CPOE as efficient, as they entered orders in the computer with much ease. However, their fear was on omitting any information and nurses seemed concerned about the time they spent on the computers other than with the patient. This study proved that nurses supported CPOE as an effective measure in improving quality and care in hospitals. CPOE systems have proved to be advantageous compared to paper-based systems. They are fast and are less subjected to errors, they reduce under & over prescribing, reduce the chance of incorrect drug choices, and they make it possible to identify a prescribing physician. The orders typed in the computer are securely communicated, and only accessed by other physicians who are responsible in carrying out the orders. Therefore, CPOE fosters safer patient care practices and enables the tracking of physician orders easily. However, CPOE consists of unintended consequences; one of the consequences is the workflow blocks that is in form of alerts and warnings that deem a system unsafe, therefore creating worries of data loosing or delays, and sometime distrusted by nurses. The CPOE system requires computer skills and loads of data that need entry, hence being a source of stress to nurses (Moniz, 2009, p.5). Secondly, the failure to ensure that the system is consistent with the nurse’s workflow may cause unintended consequences. Initiating Change Medication errors are common in health centers; however, CPOE is an effective remedy for these errors. This has led to many hospital institutions considering the implementation of computerized physician order entry. Adventist health is one such organization, which incorporates a variety of community hospitals with an aim of a dynamic health care for all. It develops and maintains medical practices and provides quality care in a conducive environment that attracts and maintains physicians. In addition, the organization is considering the implementation of CPOE in all its hospitals by the end of 2011, with an aim of providing better medical care. The organization’s aim is to move from a paper-based system to an electronic system, which it has applied to three of its hospitals already. As this is a newly adopted strategy that has not fully matured, it needs to be maintained, as changes in the remaining hospitals need to be addressed. According to Cohen (2005, P.13), a sense of urgency in change needs to be addressed. In this case, the organization needs to see the urgency of change in the partnering hospitals that do not have a computerized physician order entry system. These hospitals mostly serve communities, and the need for an effective and fast system is necessary, as it will reduce nurses’ workload such that they will have enough time to attend to patients. Nevertheless, the need for change has to be felt so that the leaders can be prompted to act. Secondly, change will only be successful if the management is willing and effective. In this case, the Adventist Health Management is up to the task as it has already implemented the system in only three hospitals while seven remain pending. Nevertheless, the management needs to understand the effectiveness and need of this system as pertaining the patient’s welfare. Therefore, there is need for consultation on how the system will be implemented in the remaining hospitals. In regard to the foregoing, I would personally write a proposal to all the staff and managers that seek to attract their attention and this would be done consistently until the change implementation is visible. The proposal will address the importance of computerized physician order entry and its consequences. The proposal will highlight the number of deaths that occur in the hospital annually due to medical error caused by paper work. Nevertheless, there is need for teamwork through which we will initiate change. In order to accomplish our mission, this team will be guided by clear leadership, will share a common need of urgency, and it will meet regularly to discuss the progress. My team’s focus is on the implementation of a computerized physician order entry in the hospital, and our main reasons for the change urgency are the reduction of workload, reduction of medical errors that lead to death and effective workflow, which is the vision of the team. Our vision is for the management to implement a strategy that will reduce the medical errors all over Adventist Health Organization. Most of the members are nurses who are responsible for patients’ health; hence, they symbolize a major concern in the patient’s welfare that would woo the management in complying with the intended change. In order to achieve the buy–in, the team leader needs to convince members about the problem to be addressed, which in this case is the need to curb medical errors. In this stage, communication is very important, as it will avoid confusion and distrust of the new change. With the right mechanisms in place, members will begin to embrace change and see its need. The computerized physician order entry system will be accompanied by challenges such as effective computer skills, which most employees may not be familiar with, hence creating fear of change. To empower employees, there is need for change in leaders who work towards boosting the employee’s confidence. To attain long-term wins, the management should willingly support the implementation of computerized physician order entry, which will ease the work of practitioners and nurses due to the effectiveness and fastness of the computer system. There is need to make the change stick, therefore, the management will ensure that while hiring new employees, they are oriented to the new procedure of change, which entails the new expectation in the new culture so that they may start working according to the new change strategy. However, people always feel the need to be motivated by the new change. In this case, change is necessary in implementing the CPOE system, and the staff needs to feel the effects of reduction in workload and time saving. It is obvious that after change, employees tend to slip back to their old behaviors; however, for change to stick, the organizational culture has to change with the help of a committed management. To sustain this change, vigilance is expected, whereby, support is given to employees who aim transforming an organization for the benefit of everybody. Every change has an aim - the main aim of this change is to save lives that are lost due to errors that could be avoided if CPOE was in place. Conclusion Computerized physician order entry has proved to be effective in facilitating the common errors that occur; however, physicians must be ready to attend to the errors caused by the CPOE systems. Nevertheless, the organization should always encourage staff to report any unintended consequences as fast as possible in order to find ways of solving them. In addition, change should always be encouraged and embraced especially by the top management, to influence the staff in adopting to change. References Bates, D. et al. (1999). The Impact of Computerized Physician Order Entry on Medication Error Prevention. Retrieved from http://jamia.bmjjournals.com/content/6/4/313.full. Cohen, D. (2005). The heart of change field guide: tools and tactics for leading change in your organization. Harvard Business Press. Retrieved from http://books.google.com/books?id=8cf1OPE_iNUC&printsec=frontcover&source=gbs_atb#v=onepage&q&f=false. Fields, W. Jacoby, J. and McCollough, S. (2009). Effect of Computerized Physician Order Entry on Nurses and Nurses’ Work. Retrieved from http://nursing.sdsu.edu/publications/fields1419.pdf. Kazley, A. and Diana, M. (2011). Hospital computerized provider order entry adoption and quality: An examination of the United States; Health Care Management Review: January/March 2011 - Volume 36 - Issue 1 - pp 86-94. Retrieved from http://journals.lww.com/hcmrjournal/Fulltext/2011/01000/Hospital_computerized_provider_order_entry.12.aspx Moniz, B (2009). Examining the Unintended Consequences of Computerized Provider Order Entry System Implementation. Online Journal of Nursing Informatics, 13(1). Retrieved from http://ojni.org/13_1/moniz.pdf. Read More