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Take a critical look at the value of CPOE systems

Nurse Leader Weekly, March 26, 2003

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A growing number of facilities have moved towards computerized physician order entry systems (CPOE) in an effort to improve patient safety and decrease medication errors. Health care leaders report success with CPOEs, citing significant improvements both in the amount of time it takes for patients to receive medications and in policy enforcement. As a leader in your facility, your input into CPOE is crucial.

When considering using a computerized physician order entry system (CPOE), many executives worry about gaining practitioners' support. But physician buy-in is just one of the components to bear in mind when considering CPOEs.

Alicia S. Miller, MS, RPh, associate director of pharmacy at the Ohio State University Medical Center in Columbus offers the following tips and insight about the CPOE system at her facility:

1. Practitioners can still select the wrong drug. Miller worried about physicians accidentally clicking on the wrong drug when dealing with look-alike medications such as Zyrtec and Zyprexa, which were listed next to each other in the system. "We're now adding the therapeutic categories to drugs with look-alike or sound-alike names to help differentiate the drugs and guide the prescriber in selecting the right drug." She added "antihistamine" to Zyrtec to help avoid confusion.

2. Nurses' expectations of medication delivery have changed. After CPOE implementation, nursing staff raised their expectations of drug delivery. Many nurses request missing medication replacement sheets five minutes after pharmacy gets the order, she says. However, pharmacists must still enter the order, prepare the drug, check the drug, and then deliver it. Miller wants to modify the missing medication notification to require nurses to wait one hour after entering the order before submitting the sheet.

3. The system doesn't support the entry of range dose or range frequency. Staff cannot enter 4-10 mg, q4-6, into the system, she says. Her facility's policy is to enter the maximum dose and shortest frequency and then write the range order in the comments. This can lead to problems if nurses fail to see the additional comments in the field and do not realize it's a range order, she says. Miller is currently working to address this problem.

Adapted from: The HCPro audioconference "The JCAHO's Medication Use Standards: Is Computerized Physician Order Entry the answer? Is CPOE just too expensive for you?" For ordering information, go to www.hcmarketplace.com.

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