CPOE’s Dramatic Impact on Nursing

Is your hospital currently using a CPOE system? CPOE, which stands for computerized provider order entry, is the module of a clinical information system that allows physicians and other providers to bypass written and verbal orders and instead enter orders (for medication, lab work, procedures, or radiology tests) directly into a computer. The system automatically transmits the orders to the department or individual responsible for carrying them out.

It’s hard to know how many hospitals have implemented CPOE, as the numbers cited on the Web range from eight to 30 percent. A 2009 report in the New England Journal of Medicine puts it at 17 percent of all hospitals. Whatever the actual statistic is now, it’s sure to rise rapidly, as CPOE is one of the core requirements for the meaningful use standard that providers are being asked to demonstrate as they integrate health care IT in to their operations. So nurses who are not already receiving orders electronically can expect this to change at some point in the near future.

Benefits of CPOE

CPOE is said to increase patient safety by eliminating common types of medication errors. These include errors that stem from illegible handwriting or a breakdown in the transcription process. It can also eliminate the delays that occur when written orders have to be hand-delivered, faxed, or phoned in.

Many CPOE systems have the added safety feature of a clinical decision support module, so prescribing physicians receive immediate alerts about drug allergies, inappropriate dosages, duplicate therapies, and drug interactions.

Effects on nursing workflow

Much has been written about overcoming physician resistance to a CPOE implementation – it seems that doctors can become frustrated when they have to completely change the way their routines or learn a new technology. Yet nurses can feel a lot of pain as well. Sometimes, too much emphasis is placed on training nurses on new hardware and software, when the real issue is workflow. CPOE completely changes unit workflow processes, and if these aren’t analyzed and redesigned before the new technology goes live, there will be complete havoc.

Getting involved: Be a super-user

The people with a lot of experience in implementing new technologies place a lot of emphasis on identifying what they call a “super-user” – oftentimes a nurse who is naturally tech-savvy, interested and enthusiastic about new tech roll-outs. You don’t need a reputation as a geek or a nursing informatics degree to stand out as a super-user, so don’t waste this opportunity! By showing your interest and willingness to get involved, you will definitely stand out as a leader.

Some specific activities you might volunteer for include testing potential hardware solutions (laptops, tablets, mobile carts) and giving input; becoming trained on the new system early in the process; and training other nurses on the system. If you show a lot of aptitude and enjoy the work, you may be asked to help roll-out the new system in other areas of the hospital, or even to help customize order sets within the system.

You may even find that becoming a super-user opens the door to a new career specialty in informatics. The Agency for Healthcare Quality and Research reports that the industry is in need of nurses who can analyze technologies from both the bedside and IT perspectives. At some point, online MSN degree in nursing informatics might even become right for you.

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