power point informatics

1. Joanna Czaplinski RN Monmouth University

2. What is CPOE? A system that allows providers to place specific orders electronically through the computer It is replacing verbal, written and fax orders

3. There are many different types of CPOE orders Examples of CPOE orders Admissions, transfers, and discharges Medication Laboratory Radiology Diet Referrals Type of precautions

4. Who Enters the Orders in CPOE ? The ordering provider Physician Nurse practitioners Physician assistants A user who enters the order in CPOE who had direct communication with the ordering provider Nurses Nurses may take a telephone or verbal order and write orders in chart and then delegate for unit assistant to put in CPOE A user other than the ordering provider who does not communicate with the ordering provider, rather follows hospital policy Nurses may enter orders based on hospital policy and nurse’s judgment Example: Fall precautions

5. CPOE’s functionality is increased with the option of clinical decision support (CDS) systems Clinical decision support systems provide decision support such as: Allergies Medication contraindications drug-diagnosis alert Medication interactions Weight based dosing

6. Where is CPOE used? Inpatient or ambulatory care setting through the use of a computer or a wireless mobile such as a PDA or tablet “The percentage of hospitals using computerized provider order entry (CPOE) jumped 167 percent, from 27 percent in 2008 to 72 percent in 2012” (Wood, 2013, para. 7). Healthcare facilities are incorporating CPOE as standard for practice (McGonigle & Mastrian , 2012, p. 219). The Institute of Medicine recommends using CPOE Ordering party Physicians, nurses, nurse practitioners, physician assistants Verifying orders party Laboratory, nurses, radiology, pharmacy, dietary, consults Who is CPOE used by?

7. CPOE Software Vendors

8. Example of CPOE screen providers use All CPOE screens vary by carrier and workplace facility Used at Raritan Bay Medical Center for CPOE orders

9. Steps to getting a medication order through CPOE Provider puts in medication order in CPOE Order is verified by pharmacy Order is verified by nurse S creens vary by carrier Shown Siemens Pharmacy and MAK 24.3.1 system MAK shown below is used at Raritan Bay Medical Center for medication verification by nurses

10. Advantages Ensures that orders are legible P revents medication errors which can save money and lives The Institute of Medicine estimates that the United States spends about $37.6 billion each year for medical errors, $17 billion of those costs are preventable ( McGonigle & Mastrian, 2012, p. 219). In 2000 about 98,000 people died as a result of medical errors in the United States ( Hoey , Nichol, & Silverman, 2009 ). Can keeps costs down if the software is used correctly Improves quality of care

11. Advantages Continued Can save time verifying orders CPOE orders are part of the Electronic Health Record Incentive Program (Centers for Medicare & Medicaid Services [CMS], 2014 ). Meaningful use of CPOE Order sets Orders can be paired by specialty or function Alerts Medication expiring, duplicate order, contraindications Will prevent illegal handwritten orders/prescriptions ( Hoey , Nichol, & Silverman, 2009 ). Detaches sound alike drugs Provides decision support

12. Disadvantages Can cause negative workflow for unit clerks as they may not be able to verify orders in a timely manner before the order is carried out (Dixon & Zafar, 2009). Needs training, which is costly and time consuming (Dixon & Zafar, 2009 ). Software can be expensive to start and maintain ( Hoey , Nichol, & Silverman, 2009 ). Can change workflow and result in less communication between healthcare professionals as a result of electronically processed orders ( Hoey , Nichol, & Silverman, 2009 ). Unavailable with computer downtime System dysfunction e- Iatrogenesis - “ patient harm caused at least in part by the application of health information technology” ( Hoey , Nichol, & Silverman, 2009, p. 1).

13. Disadvantages Continued Harder for clinicians to use who are computer illiterate Clinicians may put in orders in CPOE incorrectly Some physician resistance (McGonigle & Mastrian , 2012, p. 219). Some physicians do not like change that is associated with using CPOE and the electronic health record (Wood, 2013 ).

14. References Agency for Healthcare Research and Quality. (2009, February). Percentage of orders entered by authorized providers using cpoe . Retrieved from http:// healthit.ahrq.gov/sites/default/files/docs/page/Percent_of_Orders_Entered.pdf Centers for Medicare & Medicaid Services. (2014, May). Eligible professional meaningful use core measures measure 1 of 13. Retrieved from http:// www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/downloads/1_CPOE_for_Medication_Orders.pdf Dixon, B. E., & Zafar, A. (2009, January). Inpatient computerized provider order entry. Agency for Healthcare Research and Quality. Retrieved from http:// healthit.ahrq.gov/ahrq-funded-projects/emerging-lessons/computerized-provider-order-entry-inpatient/inpatient-computerized-provider-order-entry-cpoe Hoey , P., Nichol, W. P., & Silverman, R. (2009). Computerized provider order entry. In The pharmacy informatics primer (pp. 1-18). Bethesda, Maryland: American Society of Health-System Pharmacists . McGonigle, D. & Mastrian , K. (2012). Nursing informatics and the foundation of knowledge. (2nd ed., pp . 219 ). Boston: Jones and Bartlett Publishers. Primaris . (2006). Selecting a computerized physician order entry vendor. Retrieved from http://www.primaris.org/sites/default/files/resources/Telehealth/selecting%20a%20CPOE%20Vendor.pdf Wood, D. (2013). Ehr adoption report: The latest trends. Retrieved from http://www.amnhealthcare.com/latest-healthcare-news/ehr-adoption-report-latest-trends/