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Safety Matters

June 1, 2007
by Charlene Marietti
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A growing numbers of organizations are tackling CPOE in pursuit of improved patient safety

Charlene Marietti

There's a reason why the adoption rate of computer-based provider order entry (CPOE) systems has grown so slowly. Implementation is demanding and requires highly competent leadership to create the collaborative environments necessary just for a roll-out. Project leaders must be able to communicate goals across multiple professional groups and departments and keep momentum going.

In addition to adding efficiencies for all types of orders, CPOE is a particularly effective patient safety improvement tool in addressing medication-related errors. Adverse drug events (ADE) continue to be a leading cause of medical errors and waste billions of healthcare dollars, according to Michael Cohen, R.Ph. and president of the Huntington Valley, Pa.-based Institute for Safe Medication Practices, the independent watchdog organization focused on improving medication safety for more than 30 years.

A large number of care providers joining our Healthcare Informatics Research Panel told us recently that CPOE and electronic medical record (EMR) projects continue to be their top IT priorities. They want more information on these subjects and they want to hear about their peers' experiences.

In late April, CPOE and user experiences converged at the fourth annual Siemens CPOE Symposium held in Blue Bell, Pa. Attendance has grown steadily to this event. This year, 170 attendees gathered to share implementation strategies, challenges and unanticipated problems. No one wore rose-colored glasses.

Lots of details such as standardization of doses and medication administration times must be considered in preparation for CPOE system roll-out. “CPOE is not about technology; it's about clinical process,” notes Randall Gabel, director of business development for Healthcare Innovative Solutions Inc., Seville, Ohio.

If there was just one take-away (and there were many), it would be the necessity of a cross-disciplinary leadership with excellent communication skills to lead the project. Just as organizations differ, different professional groups and departments will encounter different problems in a CPOE roll-out. “It's amazing how differently different floors view data,” said Maureen Gaffney, R.N., RPAC, Winthrop University Hospital, Mineola, N.Y., where standardizing medication administration times was one of that facility's hurdles.

“CPOE is going to reveal a lot of things that were not visible before,” Gaffney continues. She expected there to be changes with CPOE, but still underestimated the impact. “CPOE is a catalyst for change,” she says: “What an understatement!”

Nursing's role in CPOE cannot be underestimated. “Nursing is absolutely key and without it CPOE will fail,” advises Jeri Long, R.N. and clinical applications informaticist at Denver Health Medical Center. And nurses often are project leaders.

Sometimes, they blaze the trail. SUNY-Upstate Medical Center in Syracuse, N.Y. deployed nurse order entry to its nursing staff first. In what CPOE nurse liaison Joy Ganley, R.N. calls a “nursing glue” strategy, the plan trained its entire nursing staff on the system. Then, when it rolled out CPOE to physicians, 900 nurses were at their side, acting as round-the-clock front-end support staff.

CPOE is a solid step in the right direction, but it's only one tool in the arsenal. Cohen continues to see the same medical mistakes happening over and over again. “People seem to think it won't happen to them,” he muses, imploring organizations to take the step beyond reporting an error incident. “If you hear of an incident at another institution,” he says, “embrace it as if it were your own and identify steps you need to take (to ensure it won't happen at your organization).”