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DNP 805 Topic 3 DQ 1 Describe how CPOE and CDSS embedded in the EHR can be useful towards a specific patient population of your choice

DNP 805 Topic 3 DQ 1 Describe how CPOE and CDSS embedded in the EHR can be useful towards a specific patient population of your choice

Topic 3 DQ 1

Apr 28-30, 2022

Describe how CPOE and CDSS embedded in the EHR can be useful towards a specific patient population of your choice. Identify one element of either the CPOE or CDSS you would improve that could enhance the effectiveness of the system for that patient population.

REPLY TO DISCUSSION

The use of computerized provider order entry (CPOE) and clinical decision support systems (CDSS) have greatly impacted the healthcare system. In comparison to the previous workflow where providers would have to physically handwrite orders or provide telephone orders, they can now easily enter their orders electronically. This is beneficial for all patient populations, especially adults who are admitted to the intensive care units (ICU). CPOE has contributed to patient safety in the ICUs since orders are very specific. CPOE and CDSS have prevented medication errors by about 55% as the system is able to catch miscalculations ahead of time (Metcalfe et al., 2017). Having the ability of CPOE and CDSS in place has

DNP 805 Topic 3 DQ 1 Describe how CPOE and CDSS embedded in the EHR can be useful towards a specific patient population of your choice

DNP 805 Topic 3 DQ 1 Describe how CPOE and CDSS embedded in the EHR can be useful towards a specific patient population of your choice

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also prevented uncertainties caused by illegible handwriting, which has also led to errors and patient harm in the past. CPOE has also improved administration time as it has enabled for faster communication between other departments such as the laboratory and pharmacy (Abraham et al., 2020). CPOE and CDSS have also contributed to cost reduction as it helps eliminate duplicate and unnecessary orders. In my professional opinion, having order sets in place would be an advantage for ICU patients. Since patients in the ICU have high acuities and need more frequent attention, having order sets in place for the physicians may help speed the admission process. Order sets help by ensuring appropriate orders are in place, and none are missed (Abraham et al., 2020).

References

Abraham, J., Kitsiou, S., Meng, A., Burton, S., Vatani, H., & Kannampallil, T. (2020). Effects of CPOE-based medication ordering on outcomes: an overview of systematic reviews. BMJ Quality & Safety29(10), 1–2. https://doi-org.lopes.idm.oclc.org/10.1136/bmjqs-2019-010436

 

Metcalfe, J., Lam, A., Lam, S. S. H., Clifford, J. ‐ M., & Schramm, P. (2017). Impact of the introduction of computerized physician order entry ( CPOE) on the surveillance of restricted antimicrobials and compliance with policy. Journal of Pharmacy Practice & Research47(3), 200–206. https://doi-org.lopes.idm.oclc.org/10.1002/jppr.1227

REPLY

ICU is one of those areas that have many alerts, reminders, algorithms and the high risk of medication errors and alert fatigue. The constant alarms beeping whether monitors or pumps plus orders that have algorithms and values that must be checked prior to administering of specific drugs and window periods that must be observed. It is so heartwarming to see that systems are really in place to minimize errors in a population that is already compromised by nature of the events that contributed to their placement in ICU.

REPLY

Thank you for the post. I agree with all the advantages seen in using CPOE / CDSS in the different patient population, either in the acute setting or community setting. I think these innovation of technologies continue to progress and growth each day. As nurses need to communicate with the other members of the healthcare in order to ensure that those orders will really benefit our patients. We need to work hand on hand with these technologies and importantly, we anticipate and think critically with any situations that possibly change the system. Stay safe.

REPLY

Greetings Audimar! I agreed with you when you mentioned that CPOE has contributed to patient safety in the ICUs since orders are precise. CPOE can offer safety features such as allergy alerts, drug-drug, drug-food, and drug-disease interaction checks, suggest safe medication dose ranges and intervals, guide users in implementing clinical practice guidelines and care pathways, and embed reference material (Bartman et al., 2019).  In addition, CPOE can serve as a patient safety enhancer through medicinal error elimination as well as reduction. Moreover, CPOEs can prove crucial for efficiency when concerning the submission of radiology, and lab, alongside medication towards their respective facilities and/or departments (Bartman et al., 2019).  Likewise submitting medication, lab, and radiology orders to their respective departments or facilities.  Bartman et al. (2019) also concluded that policies were designed to increase flexibility and safety, led to an increased coordination load on the healthcare team, and created new sources of error.  However, one of the biggest challenges in implementing CPOE is that it can disrupt workflow for several reasons. The first one is training. The medical staff, including doctors, nurses, and pharmacists, must learn to use the system.

Reference

Bartman, T., Bertoni, C. B., Merandi, J., Brady, M., & Bode, R. S. (2019).  Patient safety: what is working and why?. Current Treatment Options in Pediatrics, 5(2), 131-144.

REPLY

The office of the National Coordinator (ONC) for Health Information Technology defined clinical decision-support system (CDSS). It is a system that supports clinical decisions of health care practitioners, patients and other knowledgeable people to guide the clinical practice with filtered specific information to be presented at the right time to help improve the health of patients and to advance health care in general. This clinical decision support has a variety of tools which is used to improve decisions made in the clinical workflows. Some of the tools in CDSS are alerts and reminders that are computerized for the patients and clinicians, specific orders that are set to a specific condition, data reports that are focused on patients, supports with diagnostics and templates for documentations (Alexander, Hoy, & Frith, 2019). Computerized provider order entry (CPOE) is the process by which health care providers (HCP) enter and send orders and treatment instructions such as medications, laboratory, and radiology through the computer applications and not by using paper, fax, or telephone (HealtIT.gov., 2018).

The use of CDSS and CPOE that is embedded within the EHR can help to reduce errors, improve the efficiency and the safety of the care processes, increases consistency in decisions made thereby reducing increased variations which are used to provide care for the patients as well as improve the efficiency of reimbursements for care provided. It can also delay and hinder the delivery of care when the focus is on problems that lack importance and widening of digital inequalities. When the HCP enter orders into the computer, it interfaces with the EHR. It is analyzed and gives a clinical picture for the HCP of the situation of the patient. If it is abnormal, it triggers a parameter alert for the HCP to seek out the problem and perform an intervention (Alexander, Hoy, & Frith, 2019) (Mebrahtu, Skyrme, Randell, Keenan, Bloor, Yang, Andre, Ledward, King, & Thompson, 2021).

One of the tools that CDSS and CPOE is used in the cardiac patients is in the alerts that are used in the telemetry units for the heart monitors. When the patient is in distress when the vital signs are abnormal either too low or too high, the CDSS begins to alert to draw the attention of the HCP. This helps to monitor the patients and intervene promptly to prevent them from going into severe cardiac events.

One of the elements that I would like to improve would be when the monitors come off or when the patient is moving so much the alarm continues to beep. There is no distinction with the different alarms. The alarms all sound the same except when it is ventricular tachycardia or ventricular fibrillation. So, I would like to make different alarm sounds for each specific situation so that the HCP is not wandering what is causing the alarm and wasting time deciphering what is causing the alarm.

References:

Alexander, S., Hoy, H., & Frith, K. (2019). Applied clinical informatics for nurses (2nd ed.). Jones & Bartlett Learning.

HealtIT.gov. (2018, March 21). What is computerized provider order entry? | HealthIT.gov. ONC | Office of the National Coordinator for Health Information Technology. https://www.healthit.gov/faq/what-computerized-provider-order-entry

Mebrahtu, T. F., Skyrme, S., Randell, R., Keenan, A., Bloor, K., Yang, H., Andre, D., Ledward, A., King, H., & Thompson, C. (2021). Effects of computerized clinical decision support systems (CDSS) on nursing and allied health professional performance and patient outcomes: A systematic review of experimental and observational studies. BMJ Open11(12), e053886. https://doi.org/10.1136/bmjopen-2021-053886

REPLY

This is a great suggestion as the primacy of how health care facilities supervise alarms is one of the Safety goals of the Joint commission (Ruppel, 2018). Alarm fatigue can lead to persons not responding to the alarm when it goes and can overlook life-threatening changes in a patient’s condition so this is really a good idea. Thanks for sharing.

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