Nursing medication administration and work flow using computerized physician order entry - Research Paper Example

?  Nursing medication administration and work flow using computerized physician order entry The research problem in this study was on how medication errors can be reduced plus the impact of the CPOE (Computerized Physician Order Entry). The Institute of Medicine had filed an earlier report showing that nearly 7000 patients every year die due to medication errors. In minimizing medication errors and time wasted by nurses in the course of administering medications. The CPOE system became introduced with the sole purpose of reducing the time taken by nurses in ordering and administering medications. According to the observation Keohane and colleagues did on nurses activities, they found out that nurses spent 26.9 percent of their time in medication related activities compared to other work. Hence, the introduction of the CPOE system ought to have eased the nurses’ workflow plus to minimize medication errors. In the study conducted by Dana et al. (2011), the author agrees to the fact that their exists advantages and disadvantages of the CPOE system on the nurses after its introduction to help reduce the nurses work flow . The literature review in Dana et al. research is quite relevant and directly related to the problem being researched (2011). In this research, the author uses recent literature reviews to get hold of the reader’s attention concerning problems nurses faced before the introduction of CPOE system. An excellent example includes Keohane and colleague studies on the amount of time nurses spent in a variety of their activities. Another example includes a research conducted by Elganzouri et al. confirming that nurses spent a lot of time in issues dealing with medications. In the two literature review, the author would like the reader to be aware of the problems that faced the nursing team before the introduction of the CPOE system, which were spending more time on medication processes plus higher rates of medication errors. The author in the literature review critically compared and appraised key studies in a good way. Research questions in this research could have been what are the impacts of CPOE system on the nurses’ workflow? What are the disadvantages of using Computerized Physician Order Entry system to the nurses? The author’s hypotheses this case is justifiable after realizing that the introduction of CPOE systems in hospitals led to minimal interaction between nurses and physicians. In terms of the literature review, the hypotheses were not related since the literature review entirely talked of the problems nurses experience before CPOE system the introduction while the theoretical rationale speaks of the impact the system had on the nurses. The researcher offers in his justification statement that so far the CPOE system would reduce the time spent by the nurses in medication processes as evidenced by a study conducted by Bate and colleagues. By the use of DeLeon and McLean model, the research was meant to find the impact of CPOE system. The author’s hypotheses were directional since they predicted the impact of CPOE system on the nurses to be either negative or positive (Dana et al., 2011). The variable of interest from the research question will be the impact of CPOE system on the workflow of the nurses (Dana et al., 2011). In accordance to the Delone and McLean IS Success model framework, dependent variables of any information system are defined as its success. It goes further to define success as a combination of variables and include systems quality, information quality, use, individual impact, user satisfaction and organizational impact. From the author, these 6 variables are less dependent on each other than interrelated. From the research, conducted by the author, the variable being investigated is well defined. The study is predictive in nature and tries to evaluate the impact of the system on the nurses and organization in general. From his research finding, the dependent variables are organizational quality and individual quality. The independent variables are systems quality, information quality, use, and user satisfaction (Dana et al., 2011). The target populations in this research were the nurses. The research tries to get the impact of CPOE systems on the nurse’s workflow. The nurses who were available for this study were those in pediatrics unit and emergency unit. The criteria for including nurses in the study are the essence of their past having to do increased work plus the medication errors committed by the nurses (Dana et al., 2010). The sampling technique used in Dana et al. research was random sampling (2011). This is the case where the target group that got answers to what the researcher wanted were sampled and questioned randomly. Since nurses were the ones who worked with the CPOE system, any questions pertaining it had to be answered or got from them, and so the sampling was done randomly so as minimize biases. That is why the nurses were observed and asked questions pertaining the system. This method of sampling was appropriate as it targeted the main people who knew and have worked with the CPOE system. The study was biased since some time the physicians ordered some medications plus some nurses might not have been versed in ordering medications. The sampling technique used increased the probability of the research being representative of the target population. The research aimed at getting responses of nurses on the impact of the system (Dana et al., 2011). Past researches, had confirmed that it is the nurses who handled a lot of work in the hospital setting and introduction of CPOE system, was aimed at reducing their work load. Therefore, by targeting the nurses, responses got from them would have been representation of the impact of the system in the general nursing population. From the research, the sampling was appropriate. This research was conducted randomly on nurses to assess the impact of CPOE system on them. In random sampling, the randomly chosen nurses were randomly observed for non continuous 32 hours staggered over a 30 day period. The nurses were not constantly followed in their work area interfering with their dignity and privacy plus the interviews were confidential since specific names were not given (Dana et al., 2011). The methods of data collection used by Dana et al. in this study were observation and interviews (2011). In a hospital setting, the method was appropriate as it tried not to interfere with the normal working of the nurses. The advantage of observation method is that it does not involve coming into contact and interfering with the nurses work. The only disadvantage is that one might make observational errors. The advantage of interviewing the nurses was that one would get confirmation of what they had predicted of the system plus extra stuff. The only disadvantage of using it is one might get nurses who lie. After using the collection methods, observation and interviews, the researchers then followed the nurses later basing on their responses to in order to determine the nurses dislikes and likes for the CPOE system (Dana et al., 2011). From the research, it seems that the data collected was reliable though reliability quotient is not given since the method for checking the reliability of the information was adequate. The research design was quasi experiment two group posttest only design. It involved research conducted on two units; the adult medical ICU and general pediatrics unit. The design was advantageous since it took places where nurses were busy and many medication orders were being asked (Dana et al., 2011). The design was disadvantageous as it ignored nurses in other areas in the hospital who used the same system. Threat to internal validity included error variance. Some people who used observation as a way to collect data had observation errors. Threat to external validity includes reactivity. Getting cooperative nurses to go along with the research may not have been that easy. The results by the use of the research design were that nurses in the adult ICU used the system much faster compared to the nurse in pediatrics unit The research more so based on qualitative analysis and quantitative analysis to find the problem of the system (Dana et al., 2011). In terms of qualitative analysis, there were some errors spotted with the system as some items in ordering did not come. In addition, some nurses complained of it not being able to calculate some drugs and dosages to be given to patients. In terms of quantitative, a number of nurses in prenatal and emergency department were observed and it was noted that nurses in emergency section spent less time in ordering than those in other area. In the study, ten women were used. In the Dana et al. research, they use a mean of 30 days to come up with the average time (2011). From the research findings, the levels given are not quite appropriate as it is a representative of small time in a day and covered a whole month. The level of measurement of independent variables was nominal, the same to independent variables. From the research conducted, several limitations of the method used in research were spotted. First of all, the research was conducted on two in patient units in a large tertiary-care hospital (Dana et al., 2011). This study was again conducted in a hospital specialized in CPOE system hence decreasing the generalization of the research findings. In addition, there were observation errors because of observers sometimes not being keen on the steps required to administering medication plus some steps might have been quick to record. The timers also had no standard watches or time piece for investigations hence might have had some errors. The implications noted by the researcher in this case were adequate. Noting that the CPOE system was advantageous to nursing and the hospital in general in reducing workflow, it also was disadvantageous by reducing physician nurse interaction (Dana et al., 2011). From the research, it was found out that the system in as much as it helped nurses to be efficient in the work; it also had to be used carefully. Many, a times, systems have always failed in hospitals due to carelessness or computer errors. In cases of viruses, some files can be noted. It was also noted that it gave wrong calculation or interpretation to certain orders. In this research, the author displays strengths and weaknesses. Examples of common mistakes elicited by this system were errors since they commonly depended on computers (Dana et al., 2011). When a computer got infected by a virus or had hardware problems, meant that retrieval and ordering would be slowed. Hence a problem that affects computers affects them too. In addition, some doctors and nurses complained that on ordering certain drugs, the computer displayed nothing and that brought a lot of confusion when certain things were needed to be ordered real fast. Furthermore, those who were unskilled using a computer system had a rough time operating it since it was complex for them. A number of personnel even complained of the complexity of the system as it also required maintainace personnel to be always on the look out to correct failures in case of problems. Examples of strengths of the system were it assisted in reducing the time the clinicians spent in ordering for items. From their research, they concluded that these systems help to reduce the time that used to be wasted by clinicians in ordering or dispensing some items needed by patients (Dana et al., 2011). In emergency cases, it was studied to be quite useful in reducing people running around every where looking for certain things. Furthermore, it somehow reduced the burden nurses used to undergo. In the past, nurses used to run around looking for orders sent, but with the system, the process has been hastened and workflow efficiency increased. From the research, finding a system has some errors, one would try to avoid the mentioned errors while requesting for orders. For those who were computer illiterate or knew less about the computer system, proper training on its usage would have to be recommended in this case. Minimization of destructors at work can also be improved in this. In conclusion, the research was aimed at finding the impact of CPOE system in the working. Reference Dana Tschannen, A. T. (2011). Nursing Medication administration workflow using computerized physician orders entry. Computer, Informatics, Nursing , 401-410. Read More