Presented by Renae Foor

1. Define Computerized Physician Order Entry System

2. Describe hardware/software3. Review the information system4. Assess nursing implications5. Examine related legal/ethical issues6. Advantages/Disadvantages from nursing

perspective

What is

CPOE?

Computer

Physician Order

Entry is software

that allows

physicians to

directly enter

their medical

orders into a

hospital

information

system.

(Reider,

2003)

Medical orders include…MedicationLaboratory testsRadiological proceduresSurgical proceduresDietary orders

Offers access to patient records

Offers clinical decision support

Eliminates illegible handwriting

Real-time access to patient records

Offers clinical decision support

Avoids transcription errors

Speeds up response timeImproves accuracy and

completeness

(Zahn, Hicks, et al., 2006)

From a desktop computer

From a personal data assistant

From other electronic devices

(Zahn, Hicks, et al., 2006)

Lightweight, hand-held computer used as an information organizer and has communication abilities.

Keyboard or pen-basedApplications

a) Word processorb) Spreadsheetc) Calendard) Address book

Sends and receivesa) Faxesb) Datac) E-mail messages

ComputerMachine that stores and manipulates data and programs.

• Hardware – physical body

• Software – application programs

a) Word processingb) Spreadsheetsc) E-maild) Internete) Conferencing (McGonigle &

Mastrian, 2009)

The information,

such as physician

orders or test

results, is initially

entered into the

hospital database

where it is easily

accessed by

different

specialized

departments.

(Reider,

2003)

How the System Works?

Easily AccessibleChannels user through

a series of questionsUnproblematic for

experienced and inexperienced nurses

Tasks are completed with accuracy

Tasks are completed quickly

(Staggers, 2003)

CPOE systems must intersect with HIS systems like:

McKesson HISa. Booking & pre-admissionb. Admission & registrationc. Bed assignment, transfer, & discharged. Charging & claim submissione. Management & follow-upf. Customer service

(McKesson,

2008)

Allow professionals’ entry and access to data in real time to enhance quality of patient care

User involvement in all steps of the implementation of design and evaluation

Value of issues such as culture, advancement, and leadership for successful implementation

(Oroviogoicoechea, Elliot, & Watson, 2008)

Legal IssuesI. Physicians coercing nurses to

enter orders for them

II. Physicians leaving the floor to call in telephone orders

III. Patient privacy and security

IV. Physician overrides/Medical malpractice

V. Poor implementation

VI. Improper Use

VII. Deficient ergonomics

Exceptions to CPOE

1. Phone orders if no computer access

2. Emergency orders3. Protocol orders4. Verbal orders given during

procedures5. Orders during computer

system downtime

Advantages of CPOE1. Provides drug screening information2. Helps prevent adverse drug effects3. Improves quality of patient care4. Reduces drug expenses5. Provides predefined orders6. Speeds up medication ordering7. Easy accessibility to patient’s medical

orders8. Eliminates handwriting/transcription

errors9. Increases productivity and workflow10.Provides decision support

Disadvantages of CPOE1. Too much information/over-alerting2. Physician non-acceptance3. Integration/staff training4. Installation costs5. Intrusion of physician decision-

making

Nursing CompetenciesNurses utilizing CPOE will need to:a. Use the database applications to enter and

retrieve patient data/ordersb. Demonstrate basic technology skills (typing

& printing)c. Use applications for structured data entry d. Use the application to plan care for patientse. Use networks to navigate systemsf. Operate peripheral devices (PDAs)

Nursing Functions/Responsibilities1. Enter admission/discharge

orders2. Place medication and non-

medication orders3. Place ordersets4. Update allergy information5. Resolve orders conflicts6. Discontinue orders

To Review……..CPOE:1) Offers quick access to patient medication

orders2) Offers clinical decision support3) Provides drug screening information4) Helps prevent adverse drug effects5) Improves quality of patient care6) Allows real-time access to patient records7) Improves accuracy and completeness of

physician orders

ReferencesMcGonigle, D. & Mastrian, K. ( 2009). Nursing informatics and the

foundation of knowledge. Boston: Jones & Bartlett Publishers.

McKesson. (2007). HealthQuest, Retrieved December 14, 2008 from http://www.mckesson.com/en_us/McKesson.com/For+Healthcare+Providers/Hospitals

Oroviogoicoechea, C., Elliott, B., & Watson, R. (2008). Review: Evaluating Information Systems in Nursing. Journal of Clinical Nursing 17, 567-575.

Reider, J. (2003). Computerized Physician Order Entry: Has the Time Come? Medscape General Medicine, 5(2).

Stagger, N. (2003). Human Factors: Imperative Concepts for Critical

Care. AACN Clinical Issues, 14(3), 310-319. Zahn, C., Hicks, R.W., Blanchette, C.M., Keyes, M.A., & Cousins, D.D.

(2006). Potential Benefits and Problems With Computerized Prescriber. American Journal of Health System-Pharmacy, 63(4), 353-358.