Mount Auburn Hospital PEO System: Error Reduction

The purpose of this paper is to introduce Computerized Provider Order Entry (CPOE) systems in health care practice, and its impact on patient safety through a comprehensive literature review. The background and current implementation of CPOE were reviewed. The benefits and potential disadvantages of CPOE systems related to patient safety were identified, and the strength and gaps in the literature were discussed to suggest further research and guide evidence based health practice.

Steele, A. M., & DeBrow, M. (2008). Efficiency gains with computerized provider order entry. In: Henriksen K, Battles JB, Keyes MA, Grady ML (eds) Advances in patient safety: new directions and alternative approaches AHRQ publication no 08–0034-4, vol 4. Technology and Medication Safety Agency for Healthcare Research and Quality, Rockville, MD. Retrieved from http://www.ahrq.gov/qual/advances2/

Many of the nurses explained they felt the same way but learnt to adapt to the situation. By going to physician order entry it will prevent medication errors from poor handwriting and will result in less calls to the physician. Along with physician order entry, we have revised or invented order sets to have a more uniformed way of admitting patients. Once again come January it will be a long process of training and having great patience with the physicians just as they had for the nurses. We have a few family practitioners using electronic records for patients in the office but they do not have a way for the patient or the hospital to use it. So they give a print out to the patient about the visit having just general information on it. I am not aware of any physicians utilizing a website for patient information yet.

This affects the delivery of healthcare in that the information needed by providers, physicians, medical staff, and the patients themselves, may not be delivered correctly, timely, and of course securely. Various systems will be discussed and each how they affect healthcare delivery, in particular Electronic Health Record (EHR), Electronic Medical Records (EMR) and Computerized Physician Order Entry (CPOE) (also sometimes referred to as Computerized Provider Order Entry).

Computerized provider order entry (CPOE) is a significant piece of stage 1 meaningful use. CPOE in Power Chart allows for disease specific order sets decreasing the amount of free texting entries and therefore decreasing the incident of errors. Power Chart also interfaces with the hospital

Encourage the use of computer-generated or electronic medication administration records. Plan for the implementation of computerized prescriber order entry systems. Consider the use of machine-readable code (i.e., bar coding) in the medication administration process. Use computerized drug profiling in the pharmacy. Be a demanding customer of pharmacy system software; encourage vendors to incorporate and assist in implementing an adequate standardized set of checks into computerized hospital pharmacy systems (e.g., screening for duplicate drug therapies, patient allergies, potential drug interactions, drug/lab interactions, dose ranges, etc.)”. (Association,

This communication is to inform our fellow team member and most especially the physician groups about the intention of the organization to implement the Computerized Physician Order Entry (CPOE) system. The CPOE application will enable our physician provider to enter order directly into the computer system, the CPOE system will replace the old method of order entry that include, written, verbal order/telephone order, and fax. The CPOE system will enable physician to enter specifications about order such as, laboratory, medication, radiology and special procedure orders. Additionally, CPOE offers some the features of the Clinical Decision Support (CDS) at the point of order entry by recommendation dosage calculations, interactions with other medications, and warning of allergic reaction notifications with alternate medication

Health care providers as well as nurses must keep track of all pertinent patient information and failure to do so leads to detrimental effect on the patient's life. CIS clinical information systems are "large, computerized database management systems that support several types of activities that include physician order entry, result retrieval, documentation and decision support". CIS is intended to replace medical records department of a hospital or any other medical institution. Physicians and clinicians can safely and quickly access information, order medication and treatments and implement appropriate care. CIS will hopefully improve productivity, increase quality care and reduce costs across the organization.

Charles, K., Cannon, M., Hall, R., & Coustasse, A. (2014, October 1). Can utilizing a computerized provider order entry (CPOE) system prevent hospital medical errors and adverse drug events? Perspectives in Health Information Management, 11(Fall): 1b Retrieved from http://perspectives.ahima.org/can-utilizing-a-computerized-provider-order-entry-cpoe-system-prevent-hospital-medical-errors-and-adverse-drug-events/#.Vpg-Q_krLIU

NICU Nurses are responsible for care of infants who may be diagnosed with diseases, delivery complications and, the one we see most, prematurity. They develop nursing care plans and assess, plan, implement, and evaluate the effectiveness of treatments in these plans. On

As a neonatal nurse you will also be working in an office like set up to make sure that all of the paperwork for the infants is filed in the correct order then put in the correct spot. Some of the harmful things that these nurses come in contact with everyday is the critical thinking in the decisions that they are having to make of what to do for the baby, another struggle they may come across would be not getting enough sleep, then having to go to work the next day, to do their absolute best. They also need to make sure that they are washing their hands and wearing the correct equipment to keep as much bacteria and other germs away from the ill infants.

The APN leader interviewed for this paper is a Board Certified Nurse Practitioner (CNP), Chery Arnett works in the Neonatal Intensive Care Unit for Memorial Hospital of Carbondale. She began as a registered nurse in 1981, then in 2001earned her CNP title. She manages and cares for the ill neonate, collaborates with Neonatologist and Pediatricians to improve overall health outcomes. She provides support and assists ventilation, assists with deliveries both “normal” and high risk infants, provides care for the healthy newborns, also providing guidance to parents for caring for the “neonate” or healthy newborns. She is also responsible for assessments, orders, treatment plans, medications, and discharge of the infant. CNP’s provide initial, ongoing and comprehensive care, including managing patients with acute and chronic illness and diseases for both premature infants and term infants.

These tools augment the features of the EHR. They are tools that assist providers in making pertinent decisions regarding patient care. CDS provides a workflow that uses special criteria to guide healthcare providers to make sure that the appropriate treatment or procedures are done at the appropriate time. It also provides red flags to alert clinician of potential medication interactions, abnormal labs and when services are due. CDS provides many benefits that can reduced errors, improved efficiency, reduce cost and improved patient and provider satisfaction for better health

Patient’s in the NICU are considered to be very tiny and fragile and immunocompromised due to their immature organ systems which can lead to many dangerous medical problems. Patricia W. Stone states “maintaining a safe environment reflects a level of compassion and vigilance for patient welfare that is as important as any other aspect of competent health care” (Stone, 2008). The patient’s safety should always be a top concerned for a nurse because in a health care facility the purpose is to heal the patient and get them on the road to recovery. Nurses must learn from the errors of the past and use their knowledge to improve the quality of nursing to the patients to ensure if errors do happen again that the use of evidence-based practices are put into place to improve their outcomes. According to Higher Quality of Care and Patient Safety, “Registered Nurses (RNs) are instrumental in achieving multiple care goals, including promoting infant health and clinical stability, maintaining the integrity and cleanliness of central catheters, and preparing families for their role in infant care and successful transition it home” (Lake, 2016). Nurses are reasonable for the education of the families of the patients to ensure that the best quality of care for the patient is maintained outside the hospital to ensure the best medical outcome for the infants.

Information technology use in HMHP has been implemented in the past few years. The organization as a whole has gone to a system called EPIC that was at first difficult for staff to get used to but now is an asset to the organization. Advances in information technology have introduced new design approaches that support health care delivery and patient education (Demiris et al., 2008). The electronic medication administration record has made it safer for patients when receiving medications in the hospital because of the checks it uses upon administration. Also, the double verification of medication like heparin and insulin help to reduce errors. Physicians entering their own orders and having electronic notes has also made it easier to carry out orders and know what the plan entails. Information technology has also