Increased appropriateness of customized alert acknowledgement reasons for overridden medication alerts in a computerized provider order entry system

Background: Computerized provider order entry (CPOE) systems are implemented in various clinical contexts of a hospital. To identify the role of the clinical context in CPOE use, we compared the impact of a CPOE system on the medication process in both non-surgical and surgical specialties. Methods: We conducted a qualitative study of surgical and non-surgical specialties in a 1237-bed, academic hospital in the Netherlands. We interviewed the clinical end users of a computerized medication order entry system in both specialty types and analyzed the interview transcripts to elicit qualitative differences between the clinical contexts, clinicians’ attitudes, and specialty-specific requirements. Results: Our study showed that the differences in clinical contexts between non-surgical and surgical specialties resulted in a disparity between clinicians’ requirements when using CPOE. Non-surgical specialties had a greater medication workload, greater and more diverse information needs to be supported in a timely manner by the system, and thus more intensive interaction with the CPOE system. In turn these factors collectively influenced the perceived impact of the CPOE system on the clinicians’ practice. The non-surgical clinicians expressed less positive attitudes compared to the surgical clinicians, who perceived their interaction with the system to be less intensive and less problematic. Conclusion: Our study shows that clinicians’ different attitudes towards the system and the perceived impact of the system were largely grounded in the clinical context of the units. The study suggests that not merely the CPOE system, the technology itself, influences the perceptions of its users and workflow-related outcomes. The interplay between technology and clinical context of the implementation environment also matters. System design and redesigning efforts should take account of different units’ specific requirements in their particular clinical contexts.

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Impact of Computerized Provider Order Entry on Total Parenteral Nutrition in the Neonatal Intensive Care Unit

The Journal of Pediatric Pharmacology and Therapeutics ◽

10.5863/1551-6776-21.4.339 ◽

2016 ◽

Vol 21 (4) ◽

pp. 339-345 ◽

Cited By ~ 4

Author(s):

Kyle A. Franco ◽

Keliana O'Mara

Keyword(s):

Parenteral Nutrition ◽

Neonatal Intensive Care ◽

Intervention Group ◽

Preterm Neonates ◽

Control Group ◽

Order Entry ◽

Serum Electrolyte ◽

Computerized Provider Order Entry ◽

Electrolyte Disturbances ◽

Before And After

OBJECTIVES: To determine if computerized provider order entry (CPOE) implementation impacts the time it takes for preterm neonates to reach their parenteral macronutrient goals. METHODS: Retrospective review of neonates <1750 g receiving parenteral nutrition (PN) before and after the implementation of CPOE. Primary outcome was the attainment of parenteral macronutrient goals. Secondary outcomes included time to attainment, the frequency of electrolyte abnormalities, and the incidence of required adjustments made to PN orders by verification pharmacists. RESULTS: Goal PN was achieved by 12/47 (25.5%) intervention vs. 2/44 (4.5%) control group infants (p < 0.05). This goal was attained in 10.8 ± 7.5 days in the intervention group and 10 ± 4.2 days in the control group (p = 0.90). Goal protein was reached by 74.5% of CPOE patients vs. 36.4% of controls, p < 0.05. Lipid goals were achieved by 98% vs. 100% (p = 0.33) of patients and were attained at an average of 1.5 ± 0.8 days vs. 2.0 ± 1.1 days (p < 0.05). Abnormal serum electrolyte values occurred more frequently in the control group (0.79 vs. 1.12/day PN). Adjustments by a verification pharmacist were required in 5.6% of CPOE compared with 30.4% of control group orders (p < 0.05). CONCLUSIONS: CPOE parenteral nutrition increased the proportion of preterm neonates attaining overall macronutrient goals. With CPOE, protein goals were reached by more patients and goal lipids were achieved faster. This system also decreased the number of pharmacist interventions during verification of PN orders and appeared to positively impact the incidence of serum electrolyte disturbances.

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Efficacy of education followed by computerized provider order entry with clinician decision support to reduce red blood cell utilization

Transfusion ◽

10.1111/trf.13003 ◽

2015 ◽

Vol 55 (7) ◽

pp. 1628-1636 ◽

Cited By ~ 31

Author(s):

Gabriel S. Zuckerberg ◽

Andrew V. Scott ◽

Jack O. Wasey ◽

Elizabeth C. Wick ◽

Timothy M. Pawlik ◽

...

Keyword(s):

Decision Support ◽

Blood Cell ◽

Red Blood Cell ◽

Order Entry ◽

Computerized Provider Order Entry

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Optimizing vitamin D naming conventions in computerized order entry to support high-value care

Journal of the American Medical Informatics Association ◽

10.1093/jamia/ocw038 ◽

2016 ◽

Vol 24 (1) ◽

pp. 172-175 ◽

Cited By ~ 5

Author(s):

Andrew A White ◽

Christy M McKinney ◽

Noah G Hoffman ◽

Paul R Sutton

Keyword(s):

Vitamin D ◽

Time Series ◽

Decision Support Tool ◽

Human Factors Engineering ◽

Order Entry ◽

Computerized Provider Order Entry ◽

Support Tool ◽

Academic Hospitals ◽

Search Order ◽

Time Series Analyses

Objective: To reduce wasteful ordering of rare 1,25-OH vitamin D lab tests through use of a noninterruptive decision support tool. Materials and Methods: We conducted a time series quality improvement study at 2 academic hospitals. The titles of vitamin D tests and the order in which they appeared in search results were changed to reflect the purpose and rarity of the tests. We used interruptive time series analyses to evaluate the changes we made. Results: The estimated number of monthly tests ordered at the 2 hospitals increased, by 24.8 and 14.2, following the introduction of computerized provider order entry (CPOE) (both P < .001). When we changed the titles of the tests, the estimated number of monthly tests decreased at the 2 hospitals, by 22.1 and 11.3 (both P < .001). The search order did not affect test utilization. Discussion: Changing catalog names in CPOE systems for infrequently used tests can reduce unintentional overuse. Users may prefer this to interruptive or restrictive interventions. Conclusion: CPOE vendors and users should refine interfaces by incorporating human factors engineering. Health care institutions should monitor test utilization for unintended changes after CPOE implementation.

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Chapter 9: A New Frontier: Impact of the Electronic Medical Record and Computerized Provider Order Entry on Pharmacy Services

The Pharmacy Informatics Primer ◽

10.37573/9781585282753.009 ◽

2008 ◽

pp. 139-166

Keyword(s):

Medical Record ◽

Electronic Medical Record ◽

Pharmacy Services ◽

Order Entry ◽

Computerized Provider Order Entry ◽

New Frontier

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Computerized Provider Order Entry with Pager Notification Improves Efficiency in STAT Radiographic Studies and Respiratory Treatments

Applied Clinical Informatics ◽

10.4338/aci-2009-10-ra-0004 ◽

2010 ◽

Vol 01 (01) ◽

pp. 19-31 ◽

Cited By ~ 2

Author(s):

Eric Crotty ◽

Conway RRT ◽

Kim Ward Hart ◽

Craig Dietrich ◽

Scott Pettinichi RRT ◽

...

Keyword(s):

User Satisfaction ◽

Care Delivery ◽

Verbal Report ◽

Respiratory Therapy ◽

Order Entry ◽

Computerized Provider Order Entry ◽

Respiratory Therapists ◽

Radiology Technicians ◽

Picture Archiving And Communication ◽

Time Required

Summary Background: The use of computerized provider order entry (CPOE) has been widely linked to improvements in patient safety. We hypothesized that electronic routing of CPOE-generated orders through individual pagers would improve the efficiency of STAT radiographic studies and respiratory treatments. Methods: The study was conducted in two periods before and after implementing pager notification of STAT orders. In the Baseline Period, CPOE-generated STAT orders were communicated to radiology technicians or respiratory therapists through the use of printed orders, manual paging and/or telephone communication. The time to process the order and deliver a radiology result or respiratory treatment was tracked. In the Intervention Period CPOE-generated STAT orders were electronically routed to the radiology technician’s or respiratory therapist’s pager. During both time periods, clinicians completed user satisfaction surveys. Results: Using pager notification, there was a significant reduction in radiology technician arrival time (16.8±2.1 vs 7.9±0.7 mins, p<0.001). Similarly there was a significant reduction in the cumulative time required to capture the radiographic image, image availability in the picture archiving and communication system (PACS) and the verbal report from the radiologist (p<0.05). The time required in obtaining a preliminary or final radiographic written report and the total cycle times were not significantly reduced. For STAT respiratory therapy orders there was a significant reduction in the mean time from ordering to administration of respiratory therapy treatments (124.7±14.1 vs 49.8±11.4 minutes, p<0.01). Radiologists, respiratory therapists and ordering clinicians reported improved satisfaction after implementation of pager notification. Conclusion: Computer-generated orders for STAT radiographic studies and respiratory treatments can be carried out significantly faster through the use of direct pager notification. The implementation of this process has resulted in improved care delivery and widespread clinician satisfaction.

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Effectively reducing amylase testing using computer order entry in the emergency department: quality improvement without eliminating physician choice

Journal of Innovation in Health Informatics ◽

10.14236/jhi.v24i3.907 ◽

2017 ◽

Vol 24 (3) ◽

pp. 257 ◽

Cited By ~ 3

Author(s):

Cassie Jaeger ◽

Paul Sullivan ◽

James Waymack ◽

David Griffen Griffen

Keyword(s):

Emergency Department ◽

Acute Pancreatitis ◽

Abdominal Pain ◽

Diagnostic Testing ◽

Value Added ◽

Diagnostic Value ◽

Order Entry ◽

Computerized Provider Order Entry ◽

Quality Patient Care ◽

One Year

Background Amylase and lipase, pancreatic biomarkers, are measured in acute pancreatitis diagnosis. Since amylase testing does not add diagnostic value, lipase testing alone is recommended. Despite new recommendations, many physicians and staff continue to test both amylase and lipase.Objective To reduce unnecessary diagnostic testing in acute pancreatitis.Methods The pre-checked amylase test within the Emergency Department’s Computerized Provider Order Entry (CPOE) abdominal pain order set was changed to an un-checked state, but kept as an option to order with a single click. Amylase testing, lipase testing and cost were measured for one year pre and post intervention.Results Simple de-selection intervention reduced redundant amylase testing from 71% to 9%, resulting in a percent of decrease of 87% and an annualized saving of approximately $719,000 in charges.Conclusion CPOE de-selection is an effective tool to reduce non-value added activity and reduce cost while maintaining quality patient care and physician choice.

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