Feb 23, 2024 NR 361 Week 5: Trends in Informatics (graded)
NR 361 Week 5: Trends in Informatics (graded)
NR 361 Week 5: Trends in Informatics (graded)
For my Discussion, this week I chose the trend Computerized provider order entry (CPOE). “In general, CPOE serves as a tool to increase standardization, quality, and efficiency in the delivery of care provided to patients in healthcare organizations” (Kruse and Goetz, 2015). I can testify from my experience from the paper chart days, we have come a long way with the CPOE. Although one of my special talents used to be interpreting difficult to read physician orders, it is a gift that I do not miss utilizing. The EHR is a useful tool because it is better organized, easier to read, drives patient care, guides documentation, improves the speed of communication, increases productivity by guiding workflow, makes it easier to decrease costs while increasing reimbursement, and promotes safety and accountability. It improves patient care. Alerts and reminders are built to promote quality care, guide documentation, and prevent errors. Standardized terminology allows interdisciplinary communication to happen more accurately and quickly. It also aides the reimbursement process. As Heba, Hunter, and Czar state, “Organizations that implement EHR’s using standardized terminologies will observe benefits such as the ability to measure an improvement in patient care outcomes and cost efficiency” (2019). CPOE promotes privacy and accountability by requiring authors to use special names and passwords to gain access to a patient’s information.
This is also why a direct entry is the preferred technique of data entry. In my facility, on the night shift, we are continually encouraging physicians to follow policy regarding this issue. I understand the value of this because years ago I had taken a telephone order from a physician for a paper chart that resulted in a centennial event. When taken to the review board the physician attempted to deny the order was given. Fortunately, I had performed a verbal readback that was heard by my charge nurse and she was able to support me in this scenario. As far as legal, ethical, and financial considerations, there are many. Legally a provider has a responsibility to review all the patient’s data before moving forward with recommendations. There is also the responsibility to report EHR safety issues. A downfall of the built-in reminders can be alert fatigue. Ethically there are issues with patients electing not to participate in the EHR secondary to the concern of privacy issues. Vendors can sell information about data. Minors may not have access to or the right to manage their EHR. Financially the question arises, who is responsible for the payment of implementing and maintaining the system? Should it fall on the providers, the health insurers, or patients? Surprisingly, there is not a standardized protocol defining this, but I’m sure it’s only a matter of time before it will become an even hotter topic. As Kruse and Goetz suggest, “Policymakers should incentivize the adoption of CPOE through the use of levers that help organizations overcome some of the barriers” (2015).
Reference
Hebda, T., Hunter, K., & Czar, P. (2019). Handbook of informatics for nurses & healthcare professionals (6th ed.). New York, NY: Pearson.
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Kruse CS, Goetz K. Summary and Frequency of Barriers to Adoption of CPOE in the U.S. J Med Syst. 2015 02;39(2):1-5.
Select one of the following trends and discuss your understanding of this trend in healthcare and its potential impact on your practice as a nurse. What are the legal, privacy, and ethical considerations of this trend?
Nanotechnology
Consumer health informatics (CHI)
Telehealth (or telenursing)/virtual healthcare
Social media healthcare applications
Health-focused wearable technology
eHealth
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NR 361 Week 5 Trends in Informatics (graded)
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Hi Nora! Great post. Using CPOE is very different from the paper charting days! I prefer using CPOE for the benefit that there is error decrease in communication of the order. We still take verbal orders from time to time and I always read back and document, document, document… but it is scary just as you stated. If a physician denies the verbal the nurse is put into a predicament. Thank goodess in your instance, you preformed the task correctly by repeating back the order, and fortunately your charge nurse heard and was proactive for you. We are also able to take verbal orders from a provider’s office and simply ask for the person’s name and credentials of who we spoke to. I am always leary of this as well. There can be so many factors that present the possibility for error taking verbal order and written order from the physician. A language barrier can be challenging and also can cause conflict. Reading an order is a special talent! I just read a written script over the weekend that said “120mg bid” and under it said “80mg tab”… and now we are trying to get ahold of a physician on a Sunday!
CPOE has been proven to reduce the number of medication errors for hospitalized patients. It has safety features such as allergy alerts, drug-drug, drug-food, and drug-disease interaction checks, can suggest safe medication dose ranges and intervals, can guide users in implementing clinical practice guidelines and care pathways and embed reference material such as drug and disease monographs, toxicology information, and local policies and protocols (Connelly & Korvek, 2020). A drawback is that it has also been proven to increased time for workflows (Connelly & Korvek, 2020). I feel that using CPOE is a benefit for all. Nurses are able to provide safer care to patients with decreased risk of error.
Reference:
Connelly TP, Korvek SJ. Computer Provider Order Entry (CPOE) [Updated 2020 Feb 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470273/
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