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Computerized Provider Order Entry

Changing the Way of Patient Information

Molly Flood

on 31 January 2013

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Transcript of Computerized Provider Order Entry

Quiz Question 1 An application that allows providers to directly enter medication orders into a computer system, which then transmits the order to the pharmacy
Has become increasingly common in inpatient and ambulatory settings, as a strategy to reduce medication errors
Replaces more traditional methods of placing medication orders, including written (paper prescriptions), verbal (in person or via telephone), and fax
Ensures standardized, legible, and complete orders and thus has the potential to greatly reduce errors at the ordering and transcribing stages Intro and Overview of CPOE Impact on Healthcare Practice How CPOE Impacts Us -Provides helpful reminders in stressful situations
-Increases speed and Efficiency of Work
-Diminishes Communication Errors with the Doctor's Orders
-Easier for our generation to adapt to technology
-Decreases interruptions with workflow
-Older generations workflow would be disrupted
-Lowers cost of preventable errors
-Enhances relationship with patient and nurse by increasing patient safety and providing assurance
-Streamlines care from department to department Current Issues and Considerations 1) What is the order of the four stages of CPOE beginning with the clinician and ending with the nurse?

A. Dispensing, Transcribing, Administration, Ordering
B. Ordering, Transcribing, Dispensing, Administration
C. Transcribing, Ordering, Dispensing, Administration
D. Administration, Ordering, Transcribing, Dispensing Computerized Provider Order Entry Group 6 Benefits of CPOE for healthcare staff

Computerized programs can quickly alert staff of drug interactions, patient allergies, and recommended dosages
Orders can be sent out to and viewed by all involved caregivers to the patient at any location
Allows for more secure record keeping
Generates statistical information for hospital management about inventory levels and staff productivity
Increases turn-around time for lab results Benefits of CPOE for Patients

Reduces incidents of illegibility and improper abbreviation incidents, which can injure patients
Prescribing errors are the largest source of preventable hospital error
CPOE has been shown to reduce prescribing errors by 80%, very serious errors by 55%
Reduces the need for translation of illegible orders, speeding up the rate at which treatment is delivered
By reducing time spent on order processing and implementation, physicians and nurses have more time to talk with patients. CPOE is slow to adopt for some healthcare systems Costly
The cost of technology solutions is "staggeringly high" (McGonigle, 2012, p. 264).
If not implemented with proper workflow can be costly.
Duplicate and therefore redundant documentation by nursing staff can range from $6,500 to $13,000 per nurse per year (McGonigle, 2012, p. 265). Drawbacks of CPOE

Expensive to initially install and upkeep
Disrupts workflow of the staff, requires training
Inadequate amounts of work stations
Technological problems causing downtime of workstations and printers
Inability to view a patient’s record when someone else is viewing it
Inconvenience of logging on and slow processing
Complex and lengthy process of medicine ordering
Inadequate flexibility for inserting notes on patient profiles
System too sensitive to mild drug interactions For good results, CPOE should be used in a way that promotes better outcome for patients (McGonigle, 2012, p. 265). "Issues such as standardization of care, how to handle medication reconciliation, and unexpected challenges, such as changes to the post-op ordering process, lack of a human gatekeeper to monitor order flow" (Hamermesh et al., 2010). Technology is not 100% reliable.
Recent Leapfrog Group study that found CPOE systems failed to alert prescribers to more than half of the common medical errors entered (Wood, 2010). Poorly integrated CPOE can result in redundant documentation, "non-value-add steps," and more time spent on the computer rather than providing direct care.
Recent study by University of Maryland showed that nursing spends the equivalent of one full-time equivalent per year at a computer instead of on direct patient care.
Upgrades or enhancements are necessary while adapting CPOE or shortly after, leaving little time to focus efforts on optimization of the technology within the current workflow Time Consuming Patient safety and quality issues (McGonigle, 2012, p. 265) Quiz Question 2 Quiz Question 3 CPOE VIDEO 2) Although CPOE has many benefits, it also has some drawbacks. Which of the following is not a drawback of CPOE?

A. Disrupts workflow of the staff, requires training
B. Inability to view a patient’s record when someone else is viewing it
C. Orders can be sent out to and viewed by all involved caregivers to the patient at any location
D. System too sensitive to mild drug interactions 3) Some current issues and considerations concerning CPOE include which of the following:

A. It can be very costly at times
B. More time is being spent at computers resulting in less time with patients
C. Both A and B
D. None of the above Works Cited Bartos, C. E. (2008). Perceptions of personal power and their relationship to clinician's resistance to the introduction of computerized physician order entry. ProQuest. Retrieved from http://etd.library.pitt.edu
Bates, D. W., Leape, L. L., Cullen, D. J., Laird, N., Petersen, L. A., Teich, J. M., ... & Seger, D. L. (1998). Effect of computerized physician order entry and a team intervention on prevention of serious medication errors. JAMA: the journal of the American Medical Association, 280(15), 1311-1316. Retrieved from http://jama.jamanetwork.com
Computerized Physician/ Provider Order Entry. (2011, April 28). Oregon health & science university. Retrieved January 22, 2013, from: http://www.cpoe.org/
Dixon, B.E., Zafar, A. (2009, January). Inpatient computerized provider order entry (CPOE). Retrieved January 22, 2013, from: http://healthit.ahrq.gov/images/jan09cpoereport/cpoe_issue_paper.htm
Hamermesh, R.G., McFarlan, W.F., Keil, M., Morgan, M., Katz, A., & LaBorde, D. (2010, November 15). Harvard business review. Retrieved January 22, 2013, from: http://hbr.org/product/computerized-provider-order-entry-at-emory-healthc/an/311061-PDF-ENG
Koppel, R., Metlay, J. P., Cohen, A., Abaluck, B., Localio, A. R., Kimmel, S. E., & Strom, B. L. (2005). Role of computerized physician order entry systems in facilitating medication errors. JAMA: the journal of the American Medical Association, 293(10), 1197-1203. Retrieved from http://jama.jamanetwork.com
McGonigle, D., & Mastrian K.G.(2011). Nursing Informatics and the foundation of knowledge. (2). Massachusetts: Jones & Bartlett
Niazkhani, Z., Pirnejad, H., Berg, M., & Aarts, J. (2009). The impact of computerized provider order entry systems on inpatient clinical workflow: a literature review. Journal of the American Medical Informatics Association, 16(4), 539-549. Retrieved from http://jamia.bmj.com
Wood, D. (2010). Nursezone. Retrieved January 22, 2013, from: http://www.nursezone.com/nursing-news-events/devices-and-technology/Computerized-Doesnt-Mean-Foolproof-CPOE-Systems-Fail-to-Detect-Medication-Errors-Too_35546.aspx. Includes four phases starting, with the clinician and ending with the nurse
Ordering: the clinician must select the appropriate medication and the dose and frequency at which it is to be administered
Transcribing: the clerk must read the order correctly and communicate it accurately to the pharmacist
Dispensing: the pharmacist must check for drug–drug interactions and allergies, then release the appropriate quantity of the medication in the correct form
Administration: the nurse must receive the medication and supply it to the correct patient
Allows providers to not only electronically specify medication orders, but also laboratory, admission, radiology, referral, and procedure orders. Intro and Overview of CPOE
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