CPOE

Note: Although this is dated 2003, there is still good information here.

By Jean Coates, MS, RN, BC

Computerized Physician Order Entry (CPOE) Systems have various levels of functionality. Ideally, with CPOE the benefits of Drug-Drug, Drug-Food, and Drug Disease checking, along with Dose Range Checking and other rules and alerts should occur at the point of order entry...when the Provider enters the order. The Pharmacy system should have the same level of checking. One of the major drawbacks in many CPOE situations is that there is an INTERFACE instead of full integration. Often what occurs is that within the interface, some of the translation of the safety checks are diminished, often to the degree that it could actually be more efficient to write the order on paper, deliver it to the pharmacy, and have the pharmacist enter the order into the pharmacy system.

There are several articles in the literature to date that address the issue of lost patient safety factors that occur when there is not full integration with the Order Entry Component and the pharmacy system.

As facilities are looking toward implementation of CPOE, especially if this involves the purchase of an entirely new system, ensuring full integration should be a key element in your system selection criteria. Ask the vendor who does NOT have full integration but requires an interface between the Order Entry component and the pharmacy system to demonstrate the effectiveness of the key safety components of the process. I will venture to guess that there are gaps in the safety checking mechanism.

I will also go out on the limb and say that its virtually impossible to achieve 100% elimination of the problematic Verbal Order. There will always be emergency situations which require verbal orders, there will always be surgeons who are scrubbed into surgical cases and a patient will have the audacity (I am being a bit tongue in cheek here!) to have a need for unanticipated pain medication, antiemetic, etc and require receiving a verbal order through the circulating nurse in the OR.

There are other situations that exist....but there is still the ability to have the Dose Range Checking, Drug-Drug, Drug-Food, and Drug-Disease checking available to the NURSE. There should also be good policies and procedures in place to assist nursing in addressing those rules and alerts during a verbal order conversation entry in the system. Needless to say, there must be an effective mechanism within the system for those verbal orders to be co-signed by the physician.

There is a reason that only 5% of all US Hospitals have implemented CPOE: It’s a major paradigm shift in practice for Providers, Nurses and Ancillaries. I have been living through the implementation process for the last year and have felt the pain, but am also seeing the benefits.

Jean A. Coates, MS, RN, BC
Project Manager, ITG
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University of Maryland Medical System
351 W. Camden Street
Baltimore, MD 21201
Phone: 410-328-7271
Fax: 410-328-8718
Pager: 410-389-7851
Text Page: 4103897851@archwireless.net
Email: Jean Coates

Created: March 18, 2003