Computerized Physician Order Entry Institutional Assessment for Change November 6, 2012 William P Saliski RN BSN

Reason for Change  Federal Mandate – Healthcare Act under President Bush  Patient Safety by reducing medical errors through clearer order entry  Increase revenue and decrease length of stay from less medical errors

Other Factors for Change  There were too many errors being made from misinterpretation of orders that were handwritten. (Transcription Problems)  Written orders exchanged too many hands before getting to the person that needed it most, i.e. unit clerks to nurses  Decreases amount of time from when the order was entered to when it gets to done.

Stakeholders  Physicians – Less medical errors committed and higher quality of care  Nurses – More time being spent with patients and less time transcribing orders  Healthcare Facility – Better patient outcomes, increased revenue, and financial incentives  Patients – Higher quality of care and shorter length of stays

Computerized Physician Order Entry (CPOE)  Computer based program that allows for physicians to enter their own orders on the computer.  This allows for the physician to know exactly what he/she is ordering and when it will start.  Once an order is placed, it goes directly to new orders for the nurse to review.

Problems Associated with CPOE  Learning curve with the physicians and staff. Changing from paper charts to having to look up orders in the computer.  Resistance from the staff and physicians not wanting to change old ways.  Not all routine orders that physicians are familiar with were entered after the program went live. i.e. Protocols, Post- Surgical Orders  Slowing of order entry and increased physician frustration.

Fixes to the Problems  Increased information technology (IT) staff and letting them work closer in conjunction with the physicians  Set up classes for physicians and staff to attend in order to learn more about the program  Decreased resistance after almost 5 months of using the system

Vested Interests  Those who gain  Facility – Financial gain from incentives and decreased loss of money from errors. Increased patient safety.  Staff – Easier transcription of orders and more time able to spend with patients.  Those who view as a loss  Physicians – Lack of power through a change in their practice and conforming to the facility. No realization of the financial gain directly.

Human Drivers and Resistors  Human Drivers  CEO, COO, and CFO of the facility - They look at the financial benefit and increased patient safety that this could bring to the facility  Human Resistors  Physicians and Staff – They think it is easier the old way and do not want to learn a new process. They believe that it takes longer and is more of a hassle to enter all of the orders in the computer.

Other Resource Implications  More computers were made available on all of the units and floors.  Increased software and servers were added in order to handle the CPOE program.  Secondary printers were added to all areas for prescription and discharge paper printing.  Remodeling of the pharmacy in order to handle the increase in workflow.

Resource Usage  Resources used in this new program are financially burdensome in the beginning costing around $2 million to implement.  Once implemented though it can save hundreds of thousands of dollars from decreased length of stay, decreased errors, and more reimbursement from insurance companies. Facilities can also gain financial incentives through proper usage and compliance.

Conclusion  The Change  Proper orders are being entered, less errors are being committed, and more compliance from staff members is being seen.  Higher quality of care is being established at the facility due to more time being spent with the patients.  By the end of the implementation phase more staff members are becoming advocates of the system and less of resistors.