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Computerized Physician Order Entry. Presented by Keri Meyers. Objectives. Describe Computerized Physician Order Entry Describe and evaluate the hardware and software utilized with this trend. Describe and evaluate the information system used with this trend.
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Computerized Physician Order Entry Presented by Keri Meyers
Objectives • Describe Computerized Physician Order Entry • Describe and evaluate the hardware and software utilized with this trend. • Describe and evaluate the information system used with this trend. • Assess role and functions of the nurse informaticist when working with this trend. • Examine related legal/ethical issues. • Discuss the advantages/disadvantages from nursing perspective.
Computerized Physician Order Entry • Doctors enter orders into a computer system • Computer system eliminates need for hand written orders • Medication errors are greatly reduced • Designed to catch errors when the orders are first entered into system (Kuperman and Gibson, 2003)
Computerized Physician Order Entry • Over 1 million medication errors every year in U.S. hospitals • Types of medication errors • Medication errors are great financial cost in healthcare • Healthcare finances related to adverse drug effects are about $1 billion per year (The Leapfrog Group Factsheet.)
Computerized Physician Order Entry • Intercepts errors when physician enters orders • Storage of patient information • Automatic medication check • Convenient interaction with pharmacists (Kuperman and Gibson, 2003)
Types of Hardware • Computers • PCs • laptops • Palm Pilots
Computers • Microsoft Windows is needed to install the software required • PC with 300 megahertz or higher processor • Intel Pentium/Celeron family, or AMD K6/Athlon/Duron family, or compatible processor • 128 megabytes of RAM or higher • 1.5 gigabytes of available hard drive space • CD-ROM or DVD drive • Keyboard/mouse • Super VGA or higher-resolution video adaptor and monitor (Windows XP Professional System Requirements, 2009.)
Many different types of software available Consider features and capabilities System capabilities Implementation requirements Operational requirements Decision economics Examples Clin1 software Cerner Computerized Physician Order Entry Types of Software (Computerized Prescriber Order-entry Systems, 2004.)
Vital signs Laboratory results Allergies Home medications Vaccinations History and physical Physician progress notes Patient education materials Electronic prescriptions Inpatient charts Emergency department records Clin1 Software (Clinical Software Solutions, 2007-2009.)
Information Systems • What are information systems? • Computer based information systems • Other examples of information systems • Case management information systems • Communication systems • Core business systems • Order entry systems • Patient care support systems ( McGonigle & Mastrian, 2009, p. 23-24, 205-210.)
Review of SOAPware Professional • SOAPware Professional is a clinical information system • Used by physicians and nurses • Functions this system provides • Professional scheduling • Instant medical history • Order entry system • Flowsheets/growth charts • E-prescribing • Patient education handouts (Soapware Professional, 2008.)
Review of SOAPware Professional • The Certification Commission for Healthcare Information Technology (CCHIT) approved this system • Great reviews, would recommend (Soapware Professional, 2008.)
Evaluation of Usability • Axiom 1 • Users must be an early and continuous focus during interface design • Axiom 2 • The design process should be iterative, allowing for evaluation and correction of identified problems • Axiom 3 • Formal evaluation should take place using rigorous experimental and/or qualitative methods. ( McGonigle & Mastrian, 2009, p. 65-72)
Advantages • Standardization of ordering process • Decrease in transcription errors • Decrease in percentage of medication errors • Virtual access to the electronic ordering process • Able to customize ordering process to physician needs (Newell & Christensen, 2003, p 29-35.)
Disadvantages • Full physician utilization and universal compliance is required • Adoption committee required • Not as effective or useful unless it is integrated with other clinical information systems • Costs (Newell & Christensen, 2003, p 29-35.)
Ethical/Legal Issues • Health Insurance Portability and Accountability Act (HIPPA) • Must ensure that patient information is protected • Access to computer systems = access to patient information
Informatics Competencies • How to access the system • Reprinting orders as needed • Verifying orders
Responsibilities of Informatics Nurse • Reporting issues from a nursing standpoint • Educating staff nurses on the latest updates with the system
Summary • Physicians electronically enter orders • Reduces amount of medication errors • Requires computers and a software system • Many advantages and disadvantages • Plays a large role in patient safety
References • Computerized Prescriber Order-entry Systems: Evaluation, Selection. (2004.) Medscape Today. Retrieved March 1, 2009, from http://www.medscape.com/viewarticle/ 467535_9. • “Clinical Software Solutions.” (2007-2009). Clin1 Practice Management/CPOE. Retrieved February 25, 2009, from http://www.clin1.com/product-practmgmt.html
References • Factsheet Computerized Physician Order Entry. (n.d.). The Leapfrog Group. Retrieved February 8, 2009, from http://www.leapfroggroup.org/ media/file/The_Leapfrog_Group_Fact_Sheet_03_ 008.pdf. • Kuperman, G.J., & Gibson, R.F. (2003). Improving patient care. Computer physician order entry: benefits, costs, and issues. Annals of Internal Medicine, 139, 31-39. Retrieved February 5, 2009, from Cinahl database.
References • McConnell, T. (2001). Safer, cheaper, smarter: computerized physician order entry. Health Management Technology, 22, 16-18. Retrieved February 5, 2009, from Cinahl database. • McGonigle, Dee, & Magstrian, Kathleen. (2009.) Nursing Informatics and the Foundation of Knowledge. Sudbery, MA: Jones and Barlett Publishers.
References • Newell, L., & Christensen, Doug. Who’s Counting Now? ROI for Patient Safety IT Initiatives. Journal of Healthcare Information Management, 17, 29-35. • “Soapware Professional.” (2008). Retrieved March 27,2009, from http://www.soapware. com/Products/SOAPwareProfessional.aspx.
References • Windows XP Professional System Requirements. (2009). Microsoft. Retrieved February 28, 2009, from Microsoft Web site: http://www.microsoft. com/windowsxp/sysreqs/pro.mspx.