Computerized Prescribed Order Entry

Introduction

The advent of technology has greatly impacted the clinical outcomes of the health industry. For instance, computerized provider order entries (CPOE) are continually becoming widely recognized as one the most valuable tools for the improvement of the overall effectiveness and efficiency of medical work. The rising debates and academic research on the CPOE can be attributed to this factor, in which serious discussions on their potential impact on the clinical workflow and the consequences for patient safety have been receiving widespread attention. Among some of the most commonly reported workflow advantages include; the legibility of orders, the remote accessibility feature of the systems and the shortened turnaround times. These advantages and the impact of CPOE on patient safety are frequently mentioned when talking about the significance of the integration of these systems within the clinical workflow (Jozefczyk et al., 2013). Nevertheless, there are also several disadvantages that have been brought about scholars and experts. Some studies have even gone further ahead to show just how difficult the integration and implementation may be (Magid et al., 2012).

Research Aim

To this end, the discussion that has been presented herein aims to assess the benefits of CPOE, precisely by attempting to determine the effectiveness and efficiency of these systems and their application in pharmacy to reduce errors and ensuring of patient safety by protecting their health and thus saving lives.

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Computerized Prescribed Order Entry

There exists numerous studies, scholarly research, articles, academic journals and other body of knowledge that have consequently attempted to present more information on this matter. Some of the studies have asserted the significance of the various workflow issues in relation to the integration of CPOE systems and other patient safety practices.

Research Question

This current discussion purposes to provide further insights on the impact of CPOE on pharmaceutical procedures. This is to be achieved by specifically addressing the research question; ‘How to reduce medication errors by integrating CPOE systems in pharmacy?’ The understanding of the pragmatic workflow entailing CPOE can greatly assist with the improvement of the workflow that underlies such systems and thus improve health outcomes such as patient safety.

Most people have been arguing that the interruptions in the clinical workflow and outcomes that we might be experiencing today are as a result of the narrow and simplistic models that underpin healthcare information systems such as CPOE (Aarts et al., 2007). Such people present that the implementation of these simplistic models usually fails to address important aspects of clinical workflow. For instance, the systems assume and conceptualize medical workflow processes such as order creation and communication to be predefined, linear and in a stepwise manner. Yet, the clinical workflow is far from simply being a straightforward process which only entails physicians carrying out of computerized orders. Rather, medical work is fundamentally multitasking, cognitive, interruptive, collaborative, and distributive procedure. These aspects have to be understood clearly and considered when designing and implementing CPOE systems.

Article Critique

As previously mentioned, there exist a wide body of knowledge and studies that have assessed the impact of CPOE on pharmacy based on outcomes such as the turnaround time. For instance, Carmit et al. (2015) investigated the overall pharmacists’ satisfaction with CPOE and its impact on the pharmacy workflows, particularly in terms of the order verification process. The authors conducted a mixed-method study to assess the integration of CPOE and initial user experience in three hospitals within the larger Michigan health system. The study carried out surveys in two phases; before and after the implementation of CPOE systems. The authors found that the respondents had generally positive expectations before the implementation of CPOE. The same views were held during system implementation and even after several months of practical use and applications. The interviews and focus group discussions presented that the pharmacists noted a range of significant CPOE benefits but also cited a number of challenges. These challenges were particularly related to CPOE provider alerts and the uncertainty about timing of the medications. Nevertheless, the study found that after the implementation of CPOE, there was a significant decrease in the rate of order clarification as well as the average time spent clarifying orders. The authors concluded that a few months after the implementation of CPOE systems, pharmacists showed positive attitudes towards the system. They reported that several aspects of the workload had been greatly improved due to the CPOE systems. Some of these included the processes of order clarification, the ability to prioritize tasks effectively, and the ability to move around the hospital in response to demand. However, they also noted that the ambiguity in orders still existed nonetheless. As such, the CPOE systems need optimization to increase clarity and further improve the efficiencies.

Another study was carried out by Davis et al. (2014) to determine the impact of computerized prescribed order entry (CPOE) on pharmacy workload in terms of the medication turnaround time and orders that need the intervention of a pharmacist (Jon Wietholter et al., 2009). The authors acknowledged the existence of several other studies that have demonstrated how CPOE results in a reduction of the turnaround time (TAT) as well any medication errors. However, most of these studies had been conducted in large academic centers that had a relatively smaller quantity of medication orders hence yielding conflicting results. The study therefore conducted a prospective cohort study at a community medical center to assess the impact of CPOE on turnaround time and the frequency of orders that needed the intervention of a pharmacist. The authors found out that as compared to CPOE implementation, the orders that didn’t use the system were eight more likely to require the intervention of a pharmacist to prevent any medication errors. Additionally, the turnaround time for with CPOE were significantly shorter than those of the non-CPOE group. CPOE eliminated errors relating to the use of wrong dosage forms and medical formulary issues (Spaulding, 2013). As such, the study concluded that the implementation of CPOE is associated with a significant decrease in the order turnaround time and thus less likely to require the intervention of a pharmacist. Therefore, the integration of CPOE is linked with improved quality of patient care and more efficient health care delivery.

Impact of pharmacy validation in a computerized physician order entry context

Candice et al. (2007) also assessed the effects of pharmacy validation within the context of CPOE. They examined the potential benefits of CPOE in the reduction of prescribing errors and increasing the feasibility of pharmacy validation. Accordingly, the authors aimed to examine any pharmacist intervention during CPOE, the impact of the interventions on the process of prescribing and the extent to which CPOE was responsible for any identified errors. The authors found that the impact of pharmacy validation on the reduction of prescribing errors was minimal when the CPOE systems were applied. However, they concluded that the processes of pharmacy validation can also provide ongoing benefits by helping with the identification of significant improvements in CPOE which in turn will give the pharmacists the chance to concentrate on other relevant interventions.

Impact of CPOE Usage on Medication Management Process Costs and Quality Outcomes

Within pharmaceutical and inpatient setting, the management of medication is one of the key processes that directly affect the outcomes in terms of costs and quality of care. Medication processes include; order prescription, order communication, dispensing and monitoring/administration of the orders. Subsequently, electronic health records and health information systems have been emphasized as a significant resource that helps improve the above outlined processes, reducing costs and ensuring better outcomes which in turn translate to patient safety and saving lives.

This study by Spaulding and Raghu (2013) examined the overall impact of CPOE implementation on the cost and process quality outcomes in the management of medication. The authors compiled a wide array of data from several acute care hospitals in the United States that are using the CPOE systems. They assessed the relationship between the usage and implementation of CPOE and the pharmacy salary costs. To this end, the findings of this study indicated that there were numerous benefits of implementation of CPOE that were accrued when when 100% system usage had not been achieved. Therefore, CPOE usage has been greatly significant and resourceful in reducing labor costs and increasing efficiency of the previously outlined medication management processes.

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References

  • Aarts J, Ash J, Berg M. Extending the understanding of computerized physician order entry: Implications for professional collaboration, workflow and quality of care Int J Med Inform2007;76(Suppl 1):4-13Jun.
  • Carmit K. McMullen, Tara A. Macey, Jill Pope, Brian Gugerty, Marti Slot, Peter Lundeen, Joan Ash, Neil Carlson; Effect of computerized prescriber order entry on pharmacy: Experience of one health system, American Journal of Health-System Pharmacy, Volume 72, Issue 2, 15 January 2015, Pages 133–142,
  • Jon Wietholter, Susan Sitterson, Steven Allison; Effects of computerized prescriber order entry on pharmacy order-processing time, American Journal of Health-System Pharmacy, Volume 66, Issue 15, 1 August 2009, Pages 1394–1398,
  • Jozefczyk KG Kennedy WK Lin MJ et al. Computerized prescriber order entry and opportunities for medication errors: comparison to traditional paper-based order entry. J Pharm Pract . 2013; 26:434–7.
  • Lloyd Davis, Luigi Brunetti, Eui-Kyung Lee, Nari Yoon, Sung-Hee Cho, Dong-Churl Suh, Effects of computerized physician order entry on medication turnaround time and orders requiring pharmacist intervention, Research in Social and Administrative Pharmacy,Volume 10, Issue 5,2014,Pages 756-767,
  • Magid S Forrer C Shaha S . Duplicate orders: an unintended consequence of computerized provider/physician order entry (CPOE) implementation: analysis and mitigation strategies. Appl Clin Inform . 2012; 3:377–91.
  • Spaulding, T. J., & S., T. Impact of CPOE Usage on Medication Management Process Costs and Quality Outcomes. INQUIRY: The Journal of Health Care Organization, Provision, and Financing, 2013; 229–247.

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