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

Ans.) Computerized physician order entry (CPOE) is a process which helps the medical practitioners to enter and send medication orders and treatment instructions via a computer application instead of on paper charts. It is quite a helpful and error free practice. But some medical practitioners are resisting in adopting this new technique of communication, they prefers the old conventional method of giving instruction that is verbally or written.

• They feel that involvement of such things complicates the whole process.
• At first to adopt this new way of communication, it is mandatory for everyone to have the basic knowledge of computers.
• The use of COPE reduces the personal interaction of medical staff with each other.

Apart from these things, the CPOE system must have -

• User friendly and browser-based technology, making it accessible through any browser-enabled computer, any time, anywhere.
• System must be needed to be highly flexible, allowing for rapid modifications of content and functionality to meet the changing needs of a large medical staff and clinical work force.

Moreover, the foremost challenge is it adopts and learn new technology which always take some time.