Question

A good friend of yours is director of nursing at a 220-bed community hospital. Last year the hospital merged with a much larger medical center. One of the upsides, as well as one of the challenges, resulting from this change has been the rapid introduction of new computer systems. The goal is to bring the hospital “up to speed” within 3 years. At present, the Computerized Physician Order Entry (CPOE) is being implemented. The general medical and surgical units went live last month. The ICU, pediatrics, and obstetrics units are scheduled to go live next month. The plan is to work out any kinks or problems on the general units and then go live in the specialty units. Most of the physicians, nurse practitioners, and physician assistants initially complained but are now becoming more comfortable with the computers and are beginning to integrate the CPOE process into their daily routines. Several physicians are now requesting the ability to enter orders from their offices and others are looking into this option. However, three physicians have not commented during this process but are clearly resisting. For example, after performing rounds and returning to their offices they called the unit with verbal orders. After being counseled on this behavior, they began to write the orders on scraps of paper and put these in the patient’s charts or leave them at the nurses’ station. When they were informed that these were not “legal orders,” they began smuggling in order sheets from the non-activated units. In addition, they have been coercing the staff nurses on the units to enter the orders for them. This has taken two forms. Sometimes they sign in and then ask the nurses to enter the orders. Other times they ask the nurses to put the orders in verbally and then they confirm the orders. The nurses feel caught between the hospital’s goals and the need to maintain a good working relationship with these physicians.
You suggest to your friend (director of nursing) to create an informal committee to review the issues surrounding the CPOE implementation. The committee would determine methods to address these issues, prior to implementing CPOE within the ICU, pediatrics, and obstetrics units. Your friend appreciates the suggestion and forms a small committee with the following members:
• Taylor Terrific, RN – a nurse practitioner
• Dr. Dudley Do-Right – a physician who uses the CPOE system routinely and correctly
• Dr. Frank Burns – a physician who rarely, if ever, uses the CPOE system
The director of nursing asks each committee member to create a short PowerPoint presentation for the committee. The presentation would identify issues that occurred during CPOE implementation, identify potential causes of such issues, and list specific recommendations, based on strong rationale and research, to resolve the identified issues prior to the next CPOE implementation. Each committee member will have a unique perspective, based on their position (i.e., nurse, physician).
 
• Identify one or more issues, related to your role on the committee
• Identifies probable cause(s) of identified issue(s)
• States proposed solutions or processes to address the identified issues
Solutions are supported by specific rational and research. Hospital management

Answer 1

As a Nurse practitioner, my role in the committee would be to shed light on the issues faced my fellow nurses by the introduction of the new computerised physicians order entry. Some of the problems faced by the nurses are

• Inability of the physicians they work under to get used to the new system, which in term puts them in a controversial position with the physician as well as the hospital.
• Inability of the older Nursing staff to come in terms with the new technology as they were used to taking the physicians order via fax, telegram or a prescription.
• Patient work being put to a halt due to glitches in the system. This could mean a great deal of discomfort to the patients especially admitted in the emergency wards.
• Hacking of the computer system and putting the patient information at the risk of being leaked. This could be a possible threat to the organisation in the future.
• The system getting corrupt over a period of time, multitudes of patient history at the risk of being erased.

Probable causes of these issues are as follows:

• Physicians and Nurses being used to the traditional way of practicing medicine. Inability to welcome technological changes. These are mostly Physicians and Nurses who have been practicing medicine over a long period of time. Their hesitance to using newer technology could be due to lack of confidence of the CPOE. Or it could be due to them proceeding towards retirement in a few years and seeing no need to learn newer things which would not be useful for them in the future, but rather using their time to study advancements in medicine and applying them for the betterment of their patients.
• The possible cause of the issues mentioned in the last 3 points above is unfortunately the drawbacks faced by most technological interventions. Just like every other innovation, the CPOE is not a flawless software/application and has its own drawbacks, not unique from other softwares.

SOLUTIONS:

• Training of the Physicians and Nurses apprehensive of using the software. Once they realise how much it can make their life easy and less time consuming, which could be other used productively, they will slowly start to come on board. The management will have to keep its patience with such physicians as they has been conditioned to work in a certain way. Change is always uncomfortable. Time and patience is the key.
• Health informatics is still at its nascent phase and definitely requires more individuals working on it to do away with the glitches it now faces.

CONCLUSION:

Like its said before, Change is uncomfortable. time and patience is the key. unfortunately most healthcare institutes are run and successful because of its physicians and nurses, they need to be trained to be brought up to the speed with the changing world rather than finding new doctors who can take their place. the institute should understand the underlying problem as to why the software isn't used and correcting it rather than forcing it on them.