Introduction
Computerized physician order entry (CPOE) is a design or technique that has been applied in clinical practice integrating technology in the ordering of medication, laboratory test and billing of clinical data. The CPOE technique has in recent years gained prominence in healthcare settings to optimize care, minimize duplication and errors and subsequently optimize patient outcomes. The focus is on the technical aspects of the implementation process for a healthcare setting that wishes to adopt the CPOE technique (Doolan & Bates, 2002).
Method of obtaining the necessary approval(s) and securing support from your organization's leadership and fellow staff
For any new project, the success of its implementations and full utilization lies with the approval and support that the project designer receives from the organization leaders and other staff members. The CPOE project affects all aspects of the organization ranging from medication, laboratory testing, billing, and research data and also providing a reliable source for budget making (Poon et al., 2004). As such, the acceptance of the project must indicate minimal risk to the organization in terms of costs and overruns while also proving efficient for the staff with little or minimum effect on their motivation and work cultures. To achieve this, three major methodologies will be used;
1. Aligning the goals and objectives of the CPOE with the organization’s vision and mission. This method will be important in maintaining the belief that anything that aligns with the organization’s vision and mission poses no significant risk to the organizations staff, leadership or service delivery processes. At this stage, the designer will have to engage the staff and the leadership in unearthing the potential problems that they face in performing their duties and what they would wish to change of given a chance (Poon et al., 2004).
2. Identifying the CPOE major risk factors: The CPOE while offering a solution to the overheads prevalent in administering care poses a potential problem and risk to the organizations care provision. These impacts range from the performance of staff and the clinical and administrative accuracy of the CPOE. This stage will involve identifying the risks, their impacts and the probability of their occurrence. This will then be gauged against baseline data from the current practice that the project will phase out (Kuperman & Gibson, 2003). The feasibility analysis results against baseline data will assure the staff and the leadership of the level of optimization of the project.
3. Risk tolerance analysis: Once the CPOE risk analysis has been done, the project designer will have to determine how well the organization is ready or can tolerate the potential risks. Having determined the probabilities of risks and the impact, then tolerability will be much easier to determine. As long as the CPOE successfully navigates the risk feasibility analysis, tolerability will be done to determine whether the CPOE opens up the organization to any unbearable risks. Handling these risks and the readiness of the organization to such risks will be analyzed.
4. Risk management Plan: The designer having confirmed the possible risks and their tolerability will then have to develop a risk management plan which will be done collaboratively with the alders and the staff. This will be achieved through brainstorming, root-cause analysis and essential function analysis. The risk management plan will involve mitigation planning, project simulation, risk avoidance and risk transfer methodologies (Kuperman & Gibson, 2003).
Problem description
Although CPOE has been implemented in some hospitals across the United States, the current policy is seemingly inclined to paperwork with physicians and other healthcare professionals entering vital patient data in paper records. At the moment, there is no clear policy that guides order entry and as such various hospitals have adopted dissimilar models of entering orders. Entry of order in paper records is outwardly a common procedure within many hospitals in the United States. However, paper entry of patient orders has evidently been associated by very many clinical errors that subsequently hamper the safety of the patients. According to a report by Institute of Medicine (IOM), “To Err is Human”, clinical errors that emanate from poor order entry account for up to 98,000 deaths each year in the USA (Kohn et al., 2000). Disappointingly, most of these deaths are avoidable through proper order entry methods.
The IOM’s report can be termed as an eye opener to patient safety in the US and subsequently experts embarked on the most feasible standard or procedure to increase patient safety by lowering the prevalence of clinical errors. Adverse drugs events have been touted as the major causes of deaths. Various pilot projects within different hospitals have reported increased patient safety through the use of CPOE. CPOE thus comes in handy as a safer alternative as it allows physicians to record drug prescriptions, order tests and disseminate other clinical instructions via an electronic platform rather than via paper records (Kohn et al., 2000). As such, CPOE intends to bridge the apparent gap or niche that exists within the healthcare system in regard to patient safety.
Explanation of proposed solution
The primary role of the healthcare system is to provide quality care to patients in the most effective way. As much as CPOE has been touted as a pretty expensive undertaking by many healthcare facilities and hospitals, patient care should not be compromised at the expense of anything including finances. Admittedly, adoption and the subsequent implementation of CPOE are rather expensive since it requires a huge initial capital and through training of staff on the usage of the software. Even with all these challenges and barriers to implementation of CPOE, there are greater gains that accrue to the entire healthcare system in the long-run. With the demand for healthcare increasing day in day out as a result of a huge population, there is a great need to adopt clinical standards and policies that guarantee speedy recording, transmission and retrieval of data without necessarily compromising the quality of care. In this awakening effective and speedy order entry methods should be adopted as an alternative to the conventional use of paperwork. CPOE stands out as a unique development within the field of medical technology. Among the benefits that accrue to the adoption of CPOE include; ability to reduce human error significantly, time-saving ,improved order accurateness, Enriching clinical decisions during delivery of care and easy retrieval of patient data/information (Kohn et al., 2000).
Installation and adoption of CPOE is not itself sufficient without a supportive organizational culture. This underscores the need to fine-tune all aspects of care and ensure that they are aligned with this new improvement. This implies that for successful implementation of CPOE, the entire healthcare system across the country should undertake a rigorous training exercise as a way of fostering a healthy or rather holistic shift from the conventional methods to CPOE.
Rationale for selecting proposed solution
1. Setting out qualified and competent personnel for risk management: A collaborative approach is important in the choice of the most viable solution. This does not necessarily imply outsourcing the people who will make the decision regarding the project, but rather encouraging team work from within the staff to help develop and decide on the solution. Since the staff will be directly affected by the proposed solution, this approach will help eliminate resistance, inconsistencies with risk assessment and management and clearing divergent perceptions and misconceptions regarding risk management (Poon et al., 2004).
2. Adopt top-down approach in risk management: The top leadership such as the Nurse Managers and the physicians will develop their opinions about the project to suit the needs of the staff, the patients and the entire organization. This report will then be handed to the project designer who will compare the solution with their model and align and use this to harmonize the CPOE. The report and the simulation will then be handed to the staff that will air their views and opinions on the project. These will further be used by the designer to modify the project (Doolan & Bates, 2002). Repetitively, through this process, the final product will gradually satisfy the requirements of all stakeholders.
3. Creating an alliance with the stakeholders: The smallest hint of a breaking link between the designer and the stakeholders will signify a grave danger for the CPOE. Thus, the designer will continually ensure that stakeholders are informed about any new changes or modifications to the project.
Description of implementation logistics
The implementation of CPOE is essentially a change management process. Thus, the impact will be felt across board from the nurses, the medical staff, the physicians, the laboratory technicians and the accounting department and the entire organization. Thus, in the same way that the risk management process was done sung a top-down approach, the designer will engage the leadership at organizational level and educate then on the use of the CPOE. This will then gradually be trained to the other staff. Having had more experience with the systems. The Nurse Managers, departmental managers and other leaders will train the staff on the application of the CPOE in practical settings (Poon et al., 2004). Thus, change implementation will flow from the top leadership and gradually sink into the staff subsequently reforming the organizational culture. The leaders at top level and departmental level will be tasked with overseeing the full optimization of the project and reporting any overheads to the project designer.
There are various resources required for the implementation of CPOE. This ranges from human resource, physical to leadership (Kuperman and Gibson, 2003). One of the important steps of implementing the new policy is carrying out a readiness assessment of all hospitals. As such, materials such as questionnaires and interview forms will be required to assess the readiness of hospitals to adapt the new change. Once the readiness assessment stage has been accomplished, the next step of implementation is the sensitization or educational stage whereby facilitators will require various physical resources such as pamphlets, handouts, posters and projectors to undertake the sensitization program effectively. At this stage, the primary objective is to educate staff members on the importance of the change and how the change will be implemented. This stage will also involve training of staff members on how to use the software and as such computers and software will be necessary. Alongside the educational stage, evaluation will be done on a regular basis to gain understanding of whether staff members are learning (Kuperman and Gibson, 2003). Testing materials that encompass relevant stationery, press and printing materials will also be required at this stage.
The human resource aspect of the implementation will take in individuals such as facilitators and change agents. Change agents are the influential members of the hospitals, such as heads of departments and nurse administrators. The facilitators and change agents will render their services through fueling the urge to adopt the new technology and spur interest in learning (Kuperman and Gibson, 2003).
References
Doolan, D. F., & Bates, D. W. (2002). Computerized physician order entry systems in hospitals: mandates and incentives. Health affairs, 21(4), 180-188.
Kohn, L. T., Corrigan, J. M., & Donaldson, M. S. (Eds.). (2000). To Err Is Human:: Building a Safer Health System (Vol. 627). National Academies Press.
Kuperman, G. J., & Gibson, R. F. (2003). Computer physician order entry: benefits, costs, and issues. Annals of internal medicine, 139(1), 31-39.
Poon, E. G., Blumenthal, D., Jaggi, T., Honour, M. M., Bates, D. W., & Kaushal, R. (2004). Overcoming barriers to adopting and implementing computerized physician order entry systems in US hospitals. Health Affairs,23(4), 184-190.
