Nursing informatics involves integrating nursing knowledge and information with technology in managing and integrating health information. Nursing informatics has led to several healthcare delivery innovations, such as diagnostic information standardization, the use of digital health records, standardized diagnostic information, and simplified administration of health information. Nursing informatics uses health informatics in data management and information technology in care improvement and patient treatment. Since nurses are the majority of care practitioners, they are better placed to connect health care with technology. Importantly, nursing informatics enables nurses to provide evidence-based care that is also patient-centered. Additionally, nursing informatics improves clinical workflows for nurses and, therefore, effective and efficient care. In this project, I propose implementing computerized provider order entry (CPOE) to improve patient care outcomes and efficiency in our organization.
Description of the Proposed Project
The proposed nursing informatics project is the implementation of CPOE in nursing care at the healthcare facility. CPOE is an application for inputting medical orders into a computer system in an ambulatory or inpatient setting. CPOE system has been discussed for nearly 500 years, but the coverage was still less than 20% in American hospitals (Amiri, Rahimi & Khalkhali, 2020). Fortunately, CPOE is increasingly replacing the traditional methods of inputting medical orders, such as written or paper prescriptions and verbal orders made in person, through telephone or fax. The proposed CPOE systems will eventually support nurses’ efforts when making admissions, specific medical orders, procedures, referrals, and radiology orders electronically. Implementing the proposed CPOE system will entail ongoing reviews alongside modifications of existing workflows to avoid wasted efforts, process gaps, and patient harm.
Stakeholders Impacted by the Project
The project will impact the nursing care team, such as nurses who are in contact with patients most of the time. In particular, the project will help save time during patient care. CPOE will automate ordering processes. Nurses will be able to handle unreadable or unclear orders from other care providers. Unlike handwritten orders, a CPOE system has printed or typed orders, and therefore, the nurse does not have to guess whatever the other care provider could have written. Therefore, less time will be required to read and interpret the order content, resulting in more time freed for nurses to effectively provide patient care.
This project will also impact patients who may previously have made wrong medication orders. It is noteworthy that the system will have a feature that will deselects an order once a patient makes an order. Essentially, the feature will prevent possible medication errors, which has been a major problem in healthcare settings.
The project will impact the hospital’s administration, which will have to commit financial support and avail skilled human resources. CPOE implementation will require finances to acquire the system from the developers. Similarly, the project will require personnel training to acquire the necessary skills for effective implementation and goal achievement. Currently, the hospital may have an information technology administration. However, the professional, alongside the hospital’s nurse informaticist, requires training to cascade the knowledge to other cadres of care providers. Professionals from outside the hospital who are conversant with how the CPOE system works will conduct the training.
Patient Outcome This Project is Aimed at Improving and how this Improvement Would Occur
CPOE improves patient care by reducing medication errors reported in hospitals. The proposed system in this project will have a warning system that will reduce prescription errors in patient care. It is important to remember that medication errors are associated with adverse events in care settings (Kinlay et al., 2021). However, the adverse events can be prevented or limited through prompt communication, for instance where patients are located far away from care providers. The proposed project will enhance communication between patients and their care providers. Effective communication between patients and different members of a care team leads to efficient and effective care. The hospital’s care team will be able to respond to patients immediately through the system. Therefore, it is projected that the quality of patient care will significantly improve at the hospital.
Technologies Required to Implement the Project and Why
Electronic health record management will be the technology to implement in this project. The technology supports the CPOE system with standardized, complete, and legible orders. The implementation of a CPOE system requires choosing the correct elements of a user interface. For instance, the admission order section could be built in a way that when presented with more than one selection, it allows a single selection, but not more than one. Radio buttons can be used at user-interface to prevent an end user from making more than one selection (Connelly & Korvek, 2022). A radio button is a user interface that only indicates a single item to choose from an option list. Therefore, whenever a user clicks the button for a medication and then selects a radio button for another incorrect medication, the selection indicator for the correct medication automatically deselects, thereby preventing both orders for the correct and incorrect medications. Besides, the user interface could have a drop-down menu configured to only allow the selection of one option.
A workflow design is also important, particularly with standardized sets of orders for routine activities such as admission of patients. Nurses require medical information to complete clinical processes (Hayavi-haghighi, Alipour & Dehghani, 2021). A standardized order workflow design complements a nurse’s effort to complete a clinical process. Unfortunately, placing an individual order search in an entire search catalog leads to a laborious admission process (Connelly & Korvek, 2022). In contrast, a properly designed order catalog leads to a smooth workflow for an ordering nurse. A CPOE system may also permit personalization where a user saves a preferred order set in a pre-checked mode. There are higher chances of duplicating orders or conflicting items when using order sets built using checkboxes instead of radio buttons.
Additionally, a user interface that allows quick pick and favorite orders can be considered. The interface may be pre-defined using complete order sentences or sane defaults which are appropriate for a specific clinical setting (Connelly & Korvek, 2022). The interfaces would be best created at different departments for use at the specific departments they have been developed for. The favorite orders can be further customized for own needs to ensure efficiency and speed.
Another component of the CPOE technology is the decision support with safety features. Notable features may include alerts, drug interaction checks, suggestions for safe ranges or intervals for safe medication, user guidelines for practice implementation, care pathways alongside reference materials. The order design and flow in the decision support may influence nurses’ or patients’ decisions (Connelly & Korvek, 2022). A well configured and robust CPOE system enables even a novice health care provider to place effective orders when correct diagnoses have been made. Order sets in the proposed CPOE will be built and then used based on current evidence and reviewed after every few months, possibly every six months to ensure orders adhere to existing clinical guidelines.
Project Team by Roles and How the Nurse Informaticist would be Incorporated in the Project Team
This project will have a project leader whose role is to identify the project goal and setup the implementation of the CPOE project. The project lead will oversee the implementation of the pilot project and ensure close collaboration with the various departments with critical inputs for success. The project leader will be the point of contact between the other members of the team and the hospital’s administration.
The other member of the project will be the project coordinator for medical applications. The team member will also participate in the implementation of the system and envisage the implementation scope. The coordinator will also educate and train other team members on CPOE system issues, customize the project’s user manuals to organizational needs, and discuss the expected project outcomes. The coordinator will be tasked to undertake a review in case the proposed CPOE implementation project aborts.
The project team will also include the hospital’s information technology administrator, who will help to set up the system, handle general system implementation issues, and clarify issues that other members of the project raise. The hospital’s medical records officer will be part of the project implementation team. Notably, the individual will review the project and evaluate the implementation of the system.
A nurse informaticist would help to continually improve the proposed CPOE system. Communication is, without a doubt, an important element of patient safety. Therefore, a nurse informaticist’s incorporation in the project team will be valuable in the development and improvement of the CPOE system to help reduce medical errors, delays in patient care, and care costs. In particular, the nurse informaticist could be incorporated in the project team to help to assess and analyze the needs of the system, participate in designing the CPOE based on the hospital needs, participate in the testing of the system, help implement the system through staff training, troubleshooting and escalate system issues that require specialized interventions. Additionally, the nurse informaticist could be incorporated in the project team to advice on the transition from the hospital’s current system to the proposed CPOE, evaluate system requirements and participate in developing standards and policies on how to use the system in the organization.
Electronic health record management technology has evolved over the years with the creation of systems such as CPOE. This proposal identifies CPOE as the system to implement at the hospital to reduce medication errors and improve quality care outcomes. This project will require various health and non-health care professionals to implement. The nurse informaticist is one of the health care professionals who will be involved in the implementation of the project. Importantly, the professionals will require financial support from the hospital to effectively implement the project.
References
Amiri, P., Rahimi, B., & Khalkhali, H.R. (2020). Nurses’ attitudes toward computerized provider order entry (CPOE) system: A feasibility study prior to implementation. Journal of Clinical Research in Paramedical Sciences, 9(2): e101420. DOI: https://doi.org/10.5812/jcrps.101420
Connelly, T.P., & Korvek, S.J. (2022). Computer provider order entry. National Library of Medicine. https://www.ncbi.nlm.nih.gov/books/NBK470273/
Hayavi-haghighi, M.H., Alipour, J., & Dehghani, M. (2021). Nursing errors and computerized provider order entry (CPOE). Informatics in Medicine Unlocked, 25: 100648. https://doi.org/10.1016/j.imu.2021.100648
Kinlay, M., Zheng, W.Y., Burke, R., Juraskova, I., Moles, R., & Baysari, M. (2021). Medication errors related to computerized order entry systems in hospitals and how they change over time: A narrative review. Research in Social and Administrative Pharmacy, 17(9), 1546- 1552. https://doi.org/10.1016/j.sapharm.2020.12.004
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