1. Implementing Physician's Computerized Order Entry as the Standard
Bailey Berto
Columbus State University
Senior project fall 2016

2. Background
Currently at Northside hospital Forsyth physicians are allowed to submit patient orders both written physically in a patient's chart or electronically through an online ordering system.
At this time the majority of the hospitalist and internal medicine doctors use all electronic ordering, and the specialty or rounding doctors hand write their orders.
All orders must be placed in the computer either by the physician themselves or from written orders transcribed by a third party who in many cases is a non-medical personnel.

3. Problem/Need for Change
Because there is no uniform system for order entry, many orders are missed both in the computer and in the charts because of multiple entry sources.
The handwriting of many physicians is nearly illegible leading to misinterpretation and error in orders.
Medication errors are increased with written orders due to misordering by the physicians, including unsafe dosages, or misinterpretation by the transcriber.
Delay in implementation of order or administration of a medication due to the extra step of transcription to the computer from paper.

4. Global Goal
The primary goal of any QI improvement is to improve quality of patient care and safety.
This specific QI project will improve patient safety and quality by decreasing medication errors, and preventing delay of care.

5. Automated Alerts Decrease Ordering Errors
When placing an order in the computer it alerts physicians if a medication dose is outside normal range, interacts with other medications, and is not recommended for certain age groups. Because of these alerts, studies have shown a decrease in medication errors especially not high risk populations (Lester, Rios-Rojas, Islam, Fazzari, & Gomolin, 2015).
In the computer there are whole ordering sets for things like delirium, pain, VTE, common labs, blood products, and venous access. This not only saves the physicians time from having search a million things for a patient, but ensures the nurse doesn't have to call the physician for small, but necessary orders. (Lester et al., 2015).

6. Decrease in Costly Medication Errors
Having suggested dosing in Computerized order entry decreases improper dosing in high risk medications. In medications like chemotherapy having a preloaded ordering set with specific options to choose from decreases the occurrence of life threatening errors in calculations or dosing. Errors can result from human miscalculation, and illegible written orders. Computer entry eliminates those possibilities making ordering high risk medications much safer (Aziz, Ur-Rahman, Qureshi, & Bukhari, 2015).

7. Decrease in Time Between Ordering and Implementing
One of the benefits of computerized ordering systems, is as soon as the physician writes an order, it is immediately viewable to not only the nurses and pharmacy, but to other doctors. This cuts down of duplicate ad conflicting orders. This also cuts down on the time it takes to implementing order by removing the time it takes to interpretation written order and transcribe it into the computer. This speeds up admissions, medication and blood administration, labs, procedures, and others (Hollister & Messenger, 2011).

8. Benefits for Pharmacy
The average time in most hospitals for a medication to be available for administration, unless a stat order, from the time it is written is 30 minutes. That is quite some time if this patient needs this medication. Pharmacists too struggle to read some written medication orders. However the time it takes for a medication that is electronically entered to be verified and entered into a patient's profile is averaged at less than 5 minutes. This decrease in time drastically improves the quality of patient care (McMullen, Macey, Pope, Gugerty, Slot, Lundeen, & Carlson, 2015).

9. Goal
The goal is by the end of one year, make electronic order entry for physicians the only form of order entry, eliminating written orders except in emergent situations.
Have every doctor attend an education session on computerized order entry and show competence in said system within 6 months.
Implement a system for checking new electronic orders within a set time frame each shift to ensure no orders are missed.

10. So why don't Physicians use Computerized Order Entry?
With all the overwhelming data in support of Computerized Order Entry, why don't many doctors use it?
There are theories such as it easier to write it or the older doctors aren't technologically savvy, however I would like to know specifically why.
I would conduct a survey for physicians of why they prefer written orders over electronic orders, and what it would take for them to start using electronic orders.

11. Equipment/supplies
Education
All doctors with rounding privileges in the hospital must take a computer documenting class
Doctors have to go into a room to write orders, no way to write orders on the go
Improving the system for entering orders from a mix of written and electronic orders to making electronic physicians order entry the standard
Many doctors have been doctors since before electronic orders, and only written orders existed
The policies are vague and no strict rules on how doctors have to submit orders.
Environmental
Policies and restrictions

12. Barriers/Solutions
One reason I have noticed why physicians use written orders is, they round on multiple patients and it is easier for them to write an order down in the charts they carry with them then to go back to the dictation room between each patient.
Some ways to assist the physicians is to provide rolling computers or tablets to assist with on the go ordering.

13. Conclusion
Improving the system for entering orders by making electronic orders the standard will improve patient care in multiple facets.
Providing resources and training for physicians to ensure compliance in a reasonable time frame will allow not only the patient's outcomes improve but ease for the physicians as well.

14. Resources
Aziz, M. T., Ur-Rehman, T., Qureshi, S., & Bukhari, N. I. (2015). Reduction in chemotherapy order errors with computerised physician order entry and clinical decision support systems. Health Information Management Journal, 44(3), doi: / Hollister, D. J., & Messenger, A. (2011). Implementation of computerized physician order entry at a community hospital. Connecticut Medicine, 75(4), Lester, P. E., Rios-Rojas, L., Islam, S., Fazzari, M. J., & Gomolin, I. H. (2015). Impact of computerized physician order entry alerts on prescribing in older patients. Drugs & Aging, 32(3), doi: /s McMullen, C. K., Macey, T. A., Pope, J., Gugerty, B., Slot, M., Lundeen, P., & Carlson, N. (2015). Effect of computerized prescriber order entry on pharmacy: Experience of one health system. American Journal Of Health-System Pharmacy, 72(2), 133. doi: /ajhp140106