Question

Find some resources using Google which are considered pro and con regarding CPOE and patient safety. Discuss why there is conflict in the literature.

Answer 1

Computerized physician order entry (CPOE) is a
computer application that supports the electron-
ic entry by physicians of patient orders for diag-
nostic and treatment services, such as medica-
tions, laboratory and other tests. It compares
new orders against standards for dosing, checks
for allergies or interactions with other drugs and
flags potential problems.

A) Some pros of CPOR and patient safety are-

I)

CPOE as Clinical Decision Support

CPOE can offer safety features such as allergy alerts, drug-drug, drug-food, and drug-disease interaction checks, can suggest safe medication dose ranges and intervals, can guide users in implementing clinical practice guidelines and care pathways, and embed reference material such as drug and disease monographs, toxicology information, and local policies and protocols. For example, often CPOE systems will have drug-disease interaction modules and clinical rule engines installed. If a clinician admits a patient with GI bleeding and attempts to order enoxaparin, such a module would alert the clinician that enoxaparin is contraindicated in a patient with gastrointestinal bleeding.

II)

CPOE Workflow

Workflow design with CPOE is extremely important. It is preferable to use standardized order sets for usual work processes like patient admission to the hospital.Order sets save time (if properly designed) to facilitate a smooth workflow for an ordering clinician. Some CPOE systems allow personalization wherein a user can save their preferences for a given order set, as in saving the choice of enoxaparin as a “pre-checked” option.

III) CPOE may also reduce medication override dispense rates from automated dispensing cabinets (ADCs), improve the mean turnaround time (TAT) for first-dose medications, increase productivity, and decrease the amount of time from medication dispensing to medication administration.

B) Cons of CPOE And patient safety-

I) CPOE and technology dependency could cripple the user’s organization when systems are down for an extended period. Users become dependent on technology to complete work and forget how to do the basic tasks.

II) Additional implications or consequences that could affect organizational work includes-

1. More/New Work for Clinicians
2. Workflow Issues
3. Never-Ending System Demands
4. Problems Related to Paper Persistence
5. Changes in Communication Patterns and Practices
6. Negative Emotions
7. Generation of New Kinds of Errors
8. Unexpected and Unintended Changes in Institutional Power Structure
9. Overdependence on TechnologyTechnology.

C) There arises many conflicts in the literature due to arising of some barriers in implication. They are-

The analysis of the ten articles revealed a total of 31 barriers present in the implementation of a CPOE system. Of the 31 barriers, 15 barriers were unique. The 15 barriers identified were: CPOE will change the ordering/filling/administration process high levels of training are required ,Efficacy – there is no universal definition of medication error to measure and compare between organizations , there is no universal CPOE solution , CPOE is complex , cost , level of adoption within an organization widely varies, poor user interface , CPOE eliminates some error but introduces new error , resistance of the clinicians due to the perception of the loss of autonomy , legal concerns ,lack adequate staffing ,it can take years to realize the decrease in error associated with a CPOE implementation, complexity of the medication ,successful implementation requires strong leadership endorsement.

This led to a conflict in the literature of different studies conducted by the researcher.