Computerized Provider Order Entry System Research Articles

Prescribing Practices at a Residential Treatment Center – from Paper to Plastic (Computers)

ABSTRACT Medication prescription procedures were reviewed at psychiatric residential treatment centers (RTC), and a quality improvement project was conducted in order to implement integrated electronic medical records (EMR) and computerized provider order entry (CPOE). To assess the impact of preexisting prescribing practices on RTCs, surveys were sent anonymously to current and past providers of regional and local RTCs. The surveys assessed the impact of the prescribing protocol on workflow, the frequency of medication errors, the impact such errors had on patient care, the overall provider satisfaction, and the discrepancies between electronic and paper charts. Current providers were then re-surveyed after implementing the integrated CPOE system in May 2020, during the COVID-19 pandemic. The first round of provider survey results revealed that the majority of staff (n = 10, 70%) observed frequent medication errors and were largely dissatisfied with the current medication ordering and administration process (n = 10; 70%). Incident Response Improvement System (IRIS) reports revealed the most common medication errors were omissions, incorrect dosing, and incorrect medications administered. After the initiation and implementation of the CPOE, staff satisfaction increased with the process (n = 14; 50%) noting that medication errors were less frequent than before (n = 14; 50%).

Improving medication safety in a paediatric hospital: a mixed-methods evaluation of a newly implemented computerised provider order entry system

ObjectivesComputerised provider order entry (CPOE) systems have been implemented around the world as a solution to reduce ordering and transcription errors. However, previous literature documented many challenges to attain this...

Impact of Computerized Provider Order Entry on Chemotherapy Medication Errors: A Systematic Review

Context: Chemotherapy errors are considered the second most common cause of fatal medication errors (ME). Currently, computerized provider order entry (CPOE) is increasingly used to prevent or decrease ME and improve the safety of the medication process. Objectives: This study was conducted to systematically review the impacts of CPOE on the incidence of chemotherapy ME, the severity of errors, and adverse drug events (ADEs) in cancer care units. Data Sources: The literature search was conducted, using 5 databases of PubMed, EMBASE, Scopus, Web of Science, and ScienceDirect between 2000 and 2020. Search terms included keywords and MESH terms related to CPOE, ME, chemotherapy, and cancer care unit. Study Selection: Articles were included in this research if they investigated the CPOE system, reported ME, and were carried out in the oncology department. Non-English papers, duplications, review studies, and conference papers were excluded. Data Extraction: The selected papers were checked carefully and related data were extracted. All eligible articles were qualitatively evaluated with a tool provided by Downs. The extracted information included the author’s name, year of publication, study location, type of study, study objectives, and main findings. Results: A total of 829 studies were retrieved. Fourteen articles met the inclusion criteria. Ten studies (71%) reported the impact of CPOE on chemotherapy ME in comparison with the paper-based ordering method. In 4 studies (29%), researchers developed a CPOE for the oncology department, and the system was then assessed concerning user experience, safety challenges as well as the effects of CPOE on ME. Nine articles (64%) reported the impact of the CPOE system on ME only in the prescribing phase, and 5 studies (36%) examined ME in all phases of the chemotherapy process. Five studies (36%) reported the impact of the CPOE system on ADEs and the severity of errors. Conclusions: Implementing CPOE is associated with a significant reduction in ME in all phases of the chemotherapy process. However, the CPOE does not prevent all MEs and may cause new difficulties. The rigorous analysis of the chemotherapy process and considering the designing principles could help developing well-designed CPOEs and minimizing ME.

Evaluation Criteria for the Effects of Decision Support Integrated into Computerized Provider Order Entry System: A Scoping Review

Context: This study was done to extract the evaluation criteria to assess the effects of decision support systems integrated with computerized provider order entry (CPOE) systems. Methods: A Scoping review search was carried out on papers published in nine electronic databases, including PubMed, Embase, ProQuest, Scopus, Web of Science, Cochrane, Science Direct, ACM digital library, and IEEE Xplore Digital Library up to February 2019. This study was conducted based on the PRISMA flow diagram. Two investigators independently worked on identifying papers published in English electronic clinical decision supports physicians used that to help decision-making during medical orders. Finally, the criteria for effects of clinical decision support systems (CDSSs) in CPOE were extracted from the selected papers. Results: Eighty-seven studies were identified matching the inclusion criteria. The most significant number of effects belonged to the medication order decision support system. Medication order decision support system studies were classified into five categories by effects: clinical effects (8 dimensions), the process of care effects (3 dimensions), user workload effects (8 dimensions), economic effects (2 dimensions), and implementation effects (5 dimensions). Conclusions: It can be concluded that the most substantial effect is related to medication decision supports within the CPOE system. These studies provide wide-ranging criteria to evaluate CDSS integrated into CPOE. It helps identify weaknesses and strengths of CDSSs within CPOE systems.

Analyse des pratiques de prescription de l’héparine sodique au pousse-seringue électrique

Report on the practices of prescribing continuous infusion of heparin sodium by syringe pump in our hospital and shed qualitative light on the protocols used in other French hospitals. We interviewed prescribers about the protocol they were using through the computerized provider order entry system. At the same time, we asked hospital pharmacists, particularly through a social network, whether in their hospital one or more protocols were used and which ones. In all, 81 prescribers responded to our request: 22 indicated prescribing the 25,000IU/50mL protocol, 7 the 20,000IU/48mL protocol, 2 the 25,000IU/48mL protocol and 14 indicated that they had no preference for one of them. Ten responded that they did not prescribe any protocols and 26 left the question unanswered. The responses of 42 pharmacists practicing in other establishments allowed us to identify 16 different protocols. Of these 42 establishments, 10 had at least two protocols. Several protocols for the administration by continuous infusion of heparin sodium with a syringe pump can coexist within a hospital. This diversity is confusing and puts patients and caregivers at risk of medication errors. Among all these protocols, it is not known whether some are riskier than others and research to clarify this unknown is warranted. Defining a national standard concentration of heparin and bringing to the market ready-to-administer solutions are measures to be promoted in order to reduce the risk of errors.

Clinician Acceptance of Order Sets for Pain Management: A Survey in Two Urban Hospitals.

Order sets are a clinical decision support (CDS) tool in computerized provider order entry systems. Order set use has been associated with improved quality of care. Particularly related to opioids and pain management, order sets have been shown to standardize and reduce the prescription of opioids. However, clinician-level barriers often limit the uptake of this CDS modality. To identify the barriers to order sets adoption, we surveyed clinicians on their training, knowledge, and perceptions related to order sets for pain management. We distributed a cross-sectional survey between October 2020 and April 2021 to clinicians eligible to place orders at two campuses of a major academic medical center. Survey questions were adapted from the widely used framework of Unified Theory of Acceptance and Use of Technology. We hypothesize that performance expectancy (PE) and facilitating conditions (FC) are associated with order set use. Survey responses were analyzed using logistic regression. The intention to use order sets for pain management was associated with PE to existing order sets, social influence (SI) by leadership and peers, and FC for electronic health record (EHR) training and function integration. Intention to use did not significantly differ by gender or clinician role. Moderate differences were observed in the perception of the effort of, and FC for, order set use across gender and roles of clinicians, particularly emergency medicine and internal medicine departments. This study attempts to identify barriers to the adoption of order sets for pain management and suggests future directions in designing and implementing CDS systems that can improve order sets adoption by clinicians. Study findings imply the importance of order set effectiveness, peer influence, and EHR integration in determining the acceptability of the order sets.

Comprehensive evaluation of using computerised provider order-entry system for hospital discharge orders

BackgroundComputerised prescriptions for Hospital Discharge Orders (HDO) are used world-wide to secure medication processes. ObjectivesTo evaluate physicians' adoption of computerised provider order-entry (CPOE) for HDO and the prescribing error rate of HDO in an acute medical care unit. SettingA prospective study was conducted in an internal medicine department over a six-month period. The use rate of CPOE for HDO edition, prescription lines concordance between CPOE-edited HDO, exit prescriptions transcribed in the discharge summary (DS), and prescribing error rate in CPOE-edited HDO were all evaluated. ResultsA total of 407 patients with HDO were included in the study. HDO were edited via CPOE system for 350 patients (86%), among which 124 (35%) were identically transcribed, 217 (62%) had discrepancies, and nine (3%) were not transcribed in the discharge summary (DS). Prescription errors were analysed using the total of 2,854 drugs prescribed on HDO. Although hospital pharmacists had signalled discrepancies and provided recommendations to the prescribers via alerting pharmaceutical interventions in CPOE 67 prescription errors (error rate of 2.3%) were found. Errors included 53 cases of refractory period disrespected, four cases of drug interactions, three cases of drug redundancies, and two cases of excessive dosage. ConclusionThis study highlights that most HDO were edited via the CPOE system. Together with pharmacist’s interventions, the CPOE system contributed to reducing the prescription error rate in HDO. However, discrepancies in the recording process to DS were frequent, calling for reinforcement of error prevention strategies upon the integration of a CPOE system in the hospital’s Electronic Health Records. Providing regular training for physicians is also a requirement.

Effects of Guideline-based Computerized Provider Order Entry Systems on the Chemotherapy Order Process: a Systematic Review.

Background:Computerized Provider Order Entry (CPOE) systems developed based on clinical guidelines are believed to greatly reduce chemotherapy medication prescription errors.Objective:The present study reviewed the effects of guideline-based CPOEs on the chemotherapy order process.Methods:PubMed, Scopus, Embase, Web of Science, and IEEE Xplore databases published up to 1 June 2020 were systematically searched for studies investigating the effect of guideline-based CPOEs on the chemotherapy order process. Moreover, the bibliography of relevant retrieved publications was also checked.Results:Nineteen articles from the five databases met the eligibility criteria and were reviewed. Eleven out of 19 (58%) articles investigated the effect of CPOEs on medication errors, and other studies examined other aspects of CPOE efficacy, including time required for chemotherapy prescriptions; Safety, policy compliance and communication between health care providers; physicians prescribing behavior; quality and safety of treatment; workflow; direct patient care time; and adherence to guidelines. In addition, 15 out of 19 mentioned the use of specific clinical guidelines.Conclusion:Evidence indicates CPOEs can positively affect the quality of healthcare service delivery for cancer patients, but there is still a dearth of clinical outcome evaluation data about the effects of these systems on patients undergoing chemotherapy. Moreover, there is limited information about guideline compliance errors, which highlights the needs for further research in this area.

Indication alerts to improve problem list documentation.

Problem lists represent an integral component of high-quality care. However, they are often inaccurate and incomplete. We studied the effects of alerts integrated into the inpatient and outpatient computerized provider order entry systems to assist in adding problems to the problem list when ordering medications that lacked a corresponding indication. We analyzed medication orders from 2 healthcare systems that used an innovative indication alert. We collected data at site 1 between December 2018 and January 2020, and at site 2 between May and June 2021. We reviewed random samples of 100 charts from each site that had problems added in response to the alert. Outcomes were: (1) alert yield, the proportion of triggered alerts that led to a problem added and (2) problem accuracy, the proportion of problems placed that were accurate by chart review. Alerts were triggered 131134, and 6178 times at sites 1 and 2, respectively, resulting in a yield of 109055 (83.2%) and 2874 (46.5%), P< .001. Orders were abandoned, for example, not completed, in 11.1% and 9.6% of orders, respectively, P<.001. Of the 100 sample problems, reviewers deemed 88% ± 3% and 91% ± 3% to be accurate, respectively, P = .65, with a mean of 90% ± 2%. Indication alerts triggered by medication orders initiated in the absence of a justifying diagnosis were useful for populating problem lists, with yields of 83.2% and 46.5% at 2 healthcare systems. Problems were placed with a reasonable level of accuracy, with 90% ± 2% of problems deemed accurate based on chart review.

Design and Implementation of a Guideline-Based Workflow Software System for Improving the Chemotherapy Process

Background: While chemotherapy is an effective method for the treatment of patients with cancer, it is a complex, multidisciplinary, and error-prone process. Paper-based protocols are commonly applied in chemotherapy; however, they fail to eliminate the complexity of this process. Therefore, a new guideline-based workflow software (GWS) system is needed to improve the workflow and quality of chemotherapy process. Methods: Planning was initiated 11 months before the system implementation and it involved a multidisciplinary group to analyze the current chemotherapy workflow and protocols for identifying the workflow components, analyzing paper-based protocols, developing computer-based protocols, and designing of systems based on an object-oriented analysis. To implement the GWS, we applied a system based on Python programming language and SQL language. Results: The conceptual model was developed based on need assessments and chemotherapy steps. A minimum dataset was developed for the electronic health records. We established examination forms for the patient management system (PMS), as well as specific standard forms for chemotherapy ordering, prescription verification and administration templates. Finally, developed GWS system consisted of a PMS, computerized provider order entry (CPOE), prescription verification system (PVS), and nursing administration system (NAS). Conclusions: A PMS, a PVS, a NAS, and a guideline-based clinical decision support system were integrated into the CPOE system to improve the chemotherapy process. Elimination of iterations and unnecessary steps in old chemotherapy workflow, improving patient safety, improvement of communication and coordination between healthcare providers, and use of updated evidence-based medicine in direct chemotherapy orders justify the deployment of GWS in the cancer care settings.

Improving Guideline-Congruent Care for Chemotherapy-Induced Nausea and Vomiting Prophylaxis in Pediatric Oncology Patients.

Chemotherapy-induced nausea and vomiting (CINV) is a very common side effect of pediatric cancer therapy. High-quality, evidence-based, pediatric-specific guidelines for prophylaxis and treatment of CINV are available. At many centers, guideline-concordant care is uncommon. We formed a multidisciplinary quality improvement team to implement guideline-concordant care for CINV prophylaxis at our center. We present the results following the first year of our interventions. We planned and implemented a multipronged approach in three key phases: (1) developing and publishing an acute CINV prophylaxis pathway, (2) education of providers, and (3) updating the computerized provider order entry system. We used iterative, sequential Plan-Do-Study-Act cycles and behavioral economic strategies to improve adherence to guideline-concordant CINV prophylaxis. We focused on aprepitant usage as a key area for improvement. At the beginning of the study period, < 50% of patients were receiving guideline-concordant CINV prophylaxis and < 15% of eligible patients were receiving aprepitant. After 1 year, more than 60% of patients were receiving guideline-concordant care and 50% of eligible patients were receiving aprepitant. We describe the development and implementation of a standardized pathway for prevention of acute CINV in pediatric oncology patients. With a multidisciplinary, multifaceted approach, we demonstrate significant improvements to guideline-congruent CINV prophylaxis.

Healthcare Quality Improvement Analytics: An Example Using Computerized Provider Order Entry.

Evaluation of sustainability after quality improvement (QI) projects in healthcare settings is an essential part of monitoring and future QI planning. With limitations in adopting quasi-experimental study design in real-world practice, healthcare professionals find it challenging to present the sustained effect of QI changes effectively. To provide quantitative methodological approaches for demonstrating the sustainability of QI projects for healthcare professionals, we conducted data analyses based on a QI project to improve the computerized provider order entry system to reduce patients’ dosing frequencies in Korea. Data were collected for 5 years: 24-month pre-intervention, 12-month intervention, and 24-month post-intervention. Then, analytic approaches including control chart, Analysis of Variance (ANOVA), and segmented regression were performed. The control chart intuitively displayed how the outcomes changed over the entire period, and ANOVA was used to test whether the outcomes differed between groups. Last, segmented regression analysis was conducted to evaluate longitudinal effects of interventions over time. We found that the impact of QI projects in healthcare settings should be initiated following the Plan–Do–Study–Act cycle and evaluated long-term effects while widening the scope of QI evaluation with sustainability. This study can serve as a guide for healthcare professionals to use a number of statistical methodologies in their QI evaluations.

A Tool for Evaluating Medication Alerting Systems: Development and Initial Assessment.

BackgroundIt is well known that recommendations from electronic medication alerts are seldom accepted or acted on by users. Key factors affecting the effectiveness of medication alerts include system usability and alert design. Thus, human factors principles that apply knowledge of human capabilities and limitations are increasingly used in the design of health technology to improve the usability of systems.ObjectiveThis study aims to evaluate a newly developed evidence-based self-assessment tool that allows the valid and reliable evaluation of computerized medication alerting systems. This tool was developed to be used by hospital staff with detailed knowledge of their hospital’s computerized provider order entry system and alerts to identify and address potential system deficiencies. In this initial assessment, we aim to determine whether the items in the tool can measure compliance of medication alerting systems with human factors principles of design, the tool can be consistently used by multiple users to assess the same system, and the items are easy to understand and perceived to be useful for assessing medication alerting systems.MethodsThe Tool for Evaluating Medication Alerting Systems (TEMAS) was developed based on human factors design principles and consisted of 66 items. In total, 18 staff members recruited across 6 hospitals used the TEMAS to assess their medication alerting systems. Data collected from participant assessments were used to evaluate the validity, reliability, and usability of the TEMAS. Validity was assessed by comparing the results of the TEMAS with those of prior in-house evaluations. Reliability was measured using Krippendorff α to determine agreement among assessors. A 7-item survey was used to determine usability.ResultsThe participants reported mostly negative (n=8) and neutral (n=7) perceptions of alerts in their medication alerting system. However, the validity of the TEMAS could not be directly tested, as participants were unaware of any results from prior in-house evaluations. The reliability of the TEMAS, as measured by Krippendorff α, was low to moderate (range 0.26-0.46); however, participant feedback suggests that individuals’ knowledge of the system varied according to their professional background. In terms of usability, 61% (11/18) of participants reported that the TEMAS items were generally easy to understand; however, participants suggested the revision of 22 items to improve clarity.ConclusionsThis initial assessment of the TEMAS allowed the identification of its components that required modification to improve usability and usefulness. It also revealed that for the TEMAS to be effective in facilitating a comprehensive assessment of a medication alerting system, it should be completed by a multidisciplinary team of hospital staff from both clinical and technical backgrounds to maximize their knowledge of systems.

Prescribing Errors With Direct Oral Anticoagulants and Their Impact on the Risk of Bleeding in Patients With Atrial Fibrillation.

Introduction:Anticoagulants are associated with significant harm when used in error, but there are limited data on potential harm of inappropriate treatment with direct oral anticoagulants (DOACs). We conducted a matched case-control study among atrial fibrillation (AF) patients admitting the hospital with a chronic treatment with DOACs, in order to assess factors associated with the risk of major bleeding.Methods:Patient data were documented using hospital’s computerized provider order entry system. Patients identified with major bleeding were defined as cases and were matched with controls based on the duration of treatment with DOACs and number of chronic medications. Appropriateness of prescribing was assessed based on the relevant clinical guidelines. Conditional logistic regression was used to evaluate the potential impact of safety-relevant prescribing errors with DOACs on major bleeding.Results:A total number of 509 eligible admissions were detected during the study period, including 64 cases of major bleeding and 445 controls. The prevalence of prescribing errors with DOACs was 33%. Most prevalent prescribing errors with DOACs were “drug dose too low” (16%) and “non-recommended combination of drugs” (11%). Safety-relevant prescribing errors with DOACs were associated with major bleeding [adjusted odds ratio (aOR) 2.17, 95% confidence interval (CI) 1.14-4.12].Conclusion:Prescribers should be aware of the potential negative impact of prescribing errors with DOACs and understand the importance of proper prescribing and regular follow-up.

Implementation of a Computerized Provider Order Entry System in a Pediatric Hospital in Canada.

The Centre Hospitalier Universitaire Sainte-Justine (Montreal, Canada) is a pediatric academic tertiary hospital that has begun the implementation of a commercial computerized provider order entry system (CPOE) in October 2019. The objectives of this paper are 1) to estimate the impact of the CPOE system on medication errors, and 2) to identify vulnerability issues related to the configuration of the CPOE system's design. Using a pre-post implementation methodology measuring medication errors captured by clinical pharmacists revealed that the implementation of a CPOE has eliminated all prescription conformity (e.g., missing fields) and legibility errors. Pharmacists have continued to detect medication errors, especially inappropriate dosing instructions, and to intervene in similar clinical situations (medication reconciliation, deprescribing, adjusting orders). Additionally, the vulnerability analysis, based on typical clinical order test cases in an inpatient pediatric setting, highlighted the need to configure a clinical decision support system that can identify inappropriate dosing instructions for pediatric patients.

Identification and Prioritization of Clinical Decision Support Functionalities Built Within A Computerized Provider Order Entry System

Background: Clinical decision support (CDS) functionalities in Computerized Provider Order Entry system (CPOE) need to be identified by the institutional healthcare providers in developing countries. In this regard, CDS functionalities should be a priority for the execution in CPOE. Objectives: Thus, our study was done to identify and prioritize the CDS functionalities in CPOE. Methods: A Two-round Modified Delphi process was used. Firstly, a systematic search was conducted in electronic databases from the date of database inception to February 2019 for identifying CDS functionalities integrated into CPOE. Studies were retrieved from databases, including PubMed, Embase, ProQuest, Scopus, Web of Science, Cochrane, Science Direct, ACM digital library, and IEEE Xplore Digital Library. Secondly, the Modified Delphi method was carried out in 2019 to provide contextual priorities regarding CDS functionalities in CPOE in two iterative rounds. A total of 12 experts working in the three Intensive Care Units (ICUs) with more than three years of experience with homegrown CPOE in Shiraz Nemazee Teaching Hospital, including two clinical pharmacists, two health information management faculty member, four cases with critical care fellowship, and four critical care experts participated in the study. The ≥ 66.6% agreement was considered as the consensus level. SPSS software version 24 was used for statistical analysis. Results: Totally, 327 studies, which met eligibility criteria were found. A number of 60 potential CDS functionalities in CPOE were identified from eligible studies. Also, 13 out of 60 CDS functionalities reached high priority consensus after 2 iterative Delphi rounds, including drug-allergy checking (83.3%), basic dosing guidance (75%), single dosing checking (66.7%), duplicate therapy checking (66.7%), drug-pregnancy alerts (75%), time-based alerts (66.7%), alert for deep vein thrombosis prophylaxis (66.7%), alerts for duplicate medication order checking (66.7%), drug-drug interaction checking (75%), intelligent dosing guidance based on the patients’ characteristics (66.7%), renal-drug problems checking (83.3%), drug-disease interaction checking (66.7%), and displaying medication/test cost (75%). Conclusions: Our study identified high-priority CDS functionalities to be considered in the CPOE system from the viewpoint of multidisciplinary experts, especially in Iran. Results of this study may be beneficial to plan, design, and implement CDS functionalities in CPOE in the ICU.

The use of a metacognition and contemplation intervention in improving student abilities to recognize order entry errors

Background and purposeTo describe a pilot study testing a metacognition and contemplative pedagogy intervention designed to improve student abilities to identify errors on orders entered into a computerized provider order entry (CPOE) system.Educational activity and setting: Student teams worked up five patient cases and entered new orders into a CPOE system. All orders entered by teams were analyzed for errors and faculty members identified fifteen orders representing the top errors and selected these for the pre-exercise, in-class contemplation activity, and post-exercise. Course instructors instructed students to identify all errors on these orders. Students completed a pre/post-survey rating their ability to enter new orders. Two weeks later, students worked up a new patient case and entered orders into the CPOE. These orders were graded and scores were compared to the 2017 cohort to determine any differences in error rates. FindingsStudy participants included 205 students The average score of correctly identified errors increased from 22% on the pre-exercise to 62.8% on the post-exercise. On the survey of their skills, students rated their ability to “accurately enter medication orders into the [electronic health record] EHR” more highly after the intervention. The 2017 cohort made 73 errors on 170 orders compared to 45 errors on 165 orders by the 2018 cohort. SummaryBased on improvements in student ability to identify order entry errors and overall positive student feedback, this strategy may be adopted by other educators looking to improve student identification of errors on orders entered into a CPOE system.

Medication errors related to computerized provider order entry systems in hospitals and how they change over time: A narrative review.

Evaluations of computerized provider order entry (CPOE) systems have revealed that reductions in certain types of medication errors occur simultaneously with the emergence of system-related errors - errors that are unlikely or not possible to occur with the use of paper-based medication charts. System-related errors appear to persist many years post-implementation of CPOE, although little is known about whether the types and rates of system-related errors that occur immediately following CPOE implementation are similar to those that endure or emerge after years of system use. To analyze and synthesize the literature on system-related errors, specifically in relation to the length of time that CPOE systems have been in use, to determine what is currently known about how system-related errors change over time. A literature search was undertaken using the PubMed database to identify English language articles published between January 2005 and March 2020 that provided original data on system-related errors resulting from CPOE system use. Studies were included if they provided results on system-related errors and information relating to the length of time that CPOE had been in use. Thirty-one studies met the inclusion criteria for this narrative review. System-related errors were identified and described during short, medium and long-term use of CPOE systems, but no single study examined how errors changed over time. In comparing findings across studies, results suggest that system-related errors persist with long-term use of CPOE systems, although likely to occur at a reduced rate. This review has highlighted a significant gap in knowledge on how system-related errors change over time. Determining what and when system-related errors occur and the system factors that contribute to their occurrence at different time points after CPOE implementation is necessary for the future prevention and mitigation of these errors.

Nurses' Attitudes Toward Computerized Provider Order Entry (CPOE) System: A Feasibility Study Prior to Implementation

Objectives: The main objective of this study was to understand the nurses' attitudes in implementation and adoption of CPOE system through Rogers’ innovation diffusion theory. Methods: This study was cross-sectional and performed in four months (from March to June, 2017). In order to understand the acceptance of the CPOE investigated level of nursing staff’s computer literacy. The major factors influencing the nursing staff’s acceptance and use of the CPOE system were examined through Rogers’ innovation diffusion theory. Data were collected using a researcher. Results: Majority of the nursing staff adopt this innovation. The level of nursing staff’s computer literacy was high (71.32%). Highly educated nursing staff were more likely to accept computer work. The acceptance or rejection of the use of a computer is related to experiencing the HIS system in nursing. Our finding showed that the received relative advantages, compatibility, the complexity of the system were 66.29%, 71.94% and 40.36% for the nursing staff. Conclusions: Majority of the nursing staff had a good degree of computer literacy. The analysis of the finding shows that CPOE systems improve the quality and safety of healthcare. CPOE increases the security and quality of health care and reduces errors.

Varying rates of patient identity verification when using computerized provider order entry.

We sought to determine rates of computerized provider order entry (CPOE) patient identity verification and when and where in the ordering process verification occurred. Fifty-five physicians from 4 healthcare systems completed simulated patient scenarios using their respective CPOE system (Epic or Cerner). Eye movements were recorded and analyzed. Across all participants patient id was verified significantly more often than not (62.4% vs 37.6%). Vendor A had significantly higher verification rates than not; vendor B had no difference. Participants using vendor A verified information significantly more often before signing the order than after (88.4% vs 11.6%); there was no difference in vendor B. The banner bar was the most frequent verification location. Factors such as CPOE design, physician training, and the use of a simulated methodology may be impacting verification rates. Verification rates vary by CPOE product, and this can have patient safety consequences.