Computerized Provider Order Entry Awareness for Nursing

Abstract

Many healthcare facilities are in the process of implementing, or planning to implement, computerized provider order entry (CPOE). In this article, we share our experience of planning for and implementing CPOE. One of our goals was to avoid unintended consequences for nurses that at best require expensive changes after implementation or worst can create unsafe situations. We are a team of nursing informaticists at a 450-bed, not-for-profit, acute-care hospital with an emergency department/level I trauma center seeing more than 300 patients per day and an average daily inpatient census of approximately 280.In our initial planning, we conducted a literature review to determine what knowledge regarding unintended consequences for nurses had already been published. We found that there was a lack of information specific to the effects on nursing of initiating CPOE. An article from the University of Illinois at Chicago, College of Nursing, 1 summarized the published literature about disruptions to nursing workflow with the implementation of clinical information systems. They concluded, as we have, that as of 2010 very little had been published about the unintended consequences to nursing, specifically in regard to CPOE implementation, and what was published did not sufficiently explain the issues or how to prevent them. We found, however, some of the communication, workflow, and workaround issues that affected providers during CPOE implementation would likely have an impact on nurses as well.Our goal was to help prepare our nurses for postimplementation workflow changes and develop a plan to prevent as many negative impacts as possible. Using several sources including the literature, provider-related information, discussions with vendors, and personnel at other sites who had previously implemented CPOE, as well as our own experience, we created a list of unintended consequences for nursing and made plans to mitigate them.After implementation, we were pleased to confirm that we had targeted the greatest areas of risk. The remediation plans presented here include the processes we put into place before and during the implementation to safeguard against identified unintended consequences. The lessons learned are our postimplementation reflections on areas we felt needed emphasis, were particularly difficult, were time consuming, or were unexpected. COMPUTERIZED PROVIDER ORDER ENTRY AWARENESS FOR NURSING: UNINTENDED CONSEQUENCES AND REMEDIATION PLAN(1) Computerized provider order entry-related workflow changes, such as actions, communications, and safeguards used to complete patient care tasks, which are not recognized prior to go-live, cause broken processes and confusion. 2

A Systematic Review of Nurses' Experiences With Unintended Consequences When Using the Electronic Health Record

“…6 Nurses, as care coordinators, are often described as the last line of defense between a patient and an error when gaps in communication and system inefficiencies arise. Nurses operate at "sharp-end" error intersections and are directly responsible for administering medications and/or choosing to initiate or delay treatments when errors occur.…”

Challenges and Strategies for Enhancing eHealth Capacity Building Programs in African Nations

“…Studies have revealed that healthcare workers' reluctance to embrace technology significantly limits their participation in eHealth activities. This is often due to their need for sufficient knowledge and skills to operate eHealth services, which results in denial and resistance towards information technologies [30][31][32]. Furthermore, the low usage of the internet among doctors in Pakistan is attributed to their insufficient IT skills.…”

Obstacles of eHealth Capacity Building and Innovation Promotion Initiative in African Countries

“…In a qualitative study on factors affecting the implementation of a standardized information system conducted in Cameroon, the findings showed that the centralized and bureaucratic organizational structure deters the allocation of finance to ICT-related activities, particularly at the lower level (district level) of the health system [17]. A study conducted by Staton et al indicates that resistance to change on the part of healthcare professionals hindered eHealth and limited involvement in eHealth standard development [18]. Similarly, Adebesin et al, [19] attributed low integration of eHealth to the inability of Health Information systems (HIS) to interoperate.…”