This assignment aims to analyze the prescribing and ordering process of opioids using the CPOE system and then design a CDSS that can be easily incorporated into the EHR. Furthermore, details regarding the clinical issues that result from the use of opioids in the emergency room are discussed, including a discussion on the rationale behind the design development; and how health practitioners can implement the CDSS through assessing challenges and their proposed solutions apply to this specific case scenario.
Clinical Issue
America is facing an opioid crisis that results in approximately 100 deaths daily due to opioid overdose (Ellis et al., 2019). The effectiveness of opioids being used for pain relief and management widely within the country and the opioid seeking behaviour of drug addicts are leading providers in the United States to prescribe more than 300 million opioid prescriptions every year (Ellis et al., 2019). Well-known abusers of opioids can gain access to more pills as a form of drug prescription in hospitals. Sometimes health practitioners are unaware that patients are selling the prescriptions or abusing the opioids until it is too late (Vetter, 2019). One recent study at John Hopkins hospital found that 90% of individuals who abuse opioids continually get a supply of the pills even after an overdose from various health institutions (Fikes et al., 2019).
CPOE is particularly important in this situation because it will analyze drug prescriptions for different patients and prevent drug errors. CPOE is quite different from traditional paper-based drug ordering since it is based on clinical decision support, which intercedes at endorsing various cautions of potential unfavourable medication errors that can occur during drug prescription. However, it has been quite a paradox to incorporate new electronic processes into clinician workflow, majorly in the sector of drug prescription, because many electronic health records clinicians are reluctant to adjust education alerts to avoid liability. Therefore, this becomes a downside that results in health practitioners navigating many cautions of minimal clinical significance.
Design Development
There are various ideas on how to solve the issue of the opioid crisis, and one of these techniques would be implementing new alerts using the CPOE system that distinguishes risks for abuse will trigger. These alerts can indicate whether a patient formerly had an opioid prescription or any other form of pain management prescription such as benzodiazepine within the past 30 days (Genco et al., 2019). These electronic health record alerts can include toxicology screening that includes drug intake information about the patient and whether they have tested positive for cocaine on marijuana within the last seven days (Fikes et al., 2019). The whole idea behind this is to present information regarding the patient that is already in the EHR to the health practitioner at the point of care to avoid the hustle are going through charts trying to find distinguished pieces of information while at the same time getting through a busy shift (Seymour et al., 2019). This will improve time management in the health institution since the health practitioners will be able to cater for many patients at the same time because all vital information regarding the health of the patient is easily presented.
The structure of this CDSS would be able to identify patients in the EHR. They are at risk by using unbiased gauges that showcase the risk of abuse and diversion of opioid prescriptions based on consensus opinions. This information is essential in building an iterative improvement process that will indicate thresholds for the triggers search so that the number of alerts that will be generated at the point of care will be able to indicate the specific prescription of opioids that best suits that particular patient.
Implementation and Adoption
Successful CDSS adoption entails full health practitioner engagement in analyzing important information regarding a particular patient based on the alerts in the electronic health records. Physicians and pharmacists within a given health care institution will have to engage with each other to ensure all electronic health record alerts are implemented by creating a steering committee to ensure sufficient engagement and buy-in (Stempniak, 2019). The alert creation process and the analysis of the system use would be influenced by Roger’s theory of diffusion of innovation (Fikes et al., 2019). This theory stipulates that adopting a particular idea gains momentum and diffuses through a given social system over time. It signifies the choice of adoption of a process to make exclusive use of innovation (Genco et al., 2019). Roger’s theory analyses the development of a process and how its reception expands if it examines the immediate benefits contrasted with current techniques, which are viable with current qualities, encounters, and any prerequisites of adopters of the process, which is guided on a more modest scale with recognizable advantages.
In this particular context, high adoption of the new medical health records alerts will be possible if the CDSS is optimally combined with a variety of quality improvement initiatives that do not change the workflow of the health practitioners to achieve the desired objectives. The gadget through which the CDSS is made accessible at the point of care should address issues that patients face, including the rationale for the implementation of the procedure as well as the potential benefits and challenges that might be experienced during execution (Genco et al., 2019). The CDSS procedure should enhance a favourable training climate which advances fruitful reception and utilization of the innovation. One of the most significant variables for achieving successful medical health care alerts is a direct exhaustive evaluation of possible obstructions before the execution and proper device measures such as extraordinary PC support and training.
Challenges and Solutions
Implementing clinical decisions is very valuable because it improves the quality of care offered to patients; however, some challenges can result from implementing these medical health record alerts. One good example of such a shortcoming is when these medical health records alert start disrupting the workflow frequently, resulting in fatigue and consequently overlooking some of these alerts (Ellis et al., 2019). Research on medical health records alert systems signifies that if these systems are compelled on vital information which is concise and timely, they will be well received and will ultimately result in a positive impact on the desired target (Stempniak, 2019). Therefore, these medical health record alerts must be validated after being thoroughly tested to guarantee an effortless implementation by ensuring support from all stakeholders throughout the process.
Conclusion
Generally, CDSS for opioid prescription management is vital for minimizing human error and directing health practitioners to correct treatment decisions. These systems will help improve clinical decision-making processes and overall patient outcomes, improving the quality of health care provided to patients. A well-built CDSS system, along with medical health care practitioner support and engagement, will ensure a very successful implementation process that will lead to increased adoption, ultimately reducing the challenges resulting from opioid prescription within various healthcare organizations in the United States.
References
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