CPOE Selection, Implementation, and Delivery
Read the following case study and answer the discussion prompts:
A good friend of yours is director of nursing at a 220-bed community hospital. Last year the hospital merged with a much larger medical center. One of the upsides, as well as one of the challenges, resulting from this change has been the rapid introduction of new computer systems. The goal is to bring the hospital “up to speed” within 3 years. At present, the Computerized Physician Order Entry (CPOE) is being implemented. The general medical and surgical units went live last month. The ICU, pediatrics, and obstetrics units are scheduled to go live next month. The plan is to work out any kinks or problems on the general units and then go live in the specialty units. Most of the physicians, nurse practitioners, and physician assistants initially complained but are now becoming more comfortable with the computers and are beginning to integrate the CPOE process into their daily routines. Several physicians are now requesting the ability to enter orders from their offices and others are looking into this option. However, three physicians have not commented during this process but are clearly resisting. For example, after performing rounds and returning to their offices they called the unit with verbal orders. After being counseled on this behavior, they began to write the orders on scraps of paper and put these in the patient’s charts or leave them at the nurses’ station. When they were informed that these were not “legal orders,” they began smuggling in order sheets from the non-activated units. In addition, they have been coercing the staff nurses on the units to enter the orders for them. This has taken two forms. Sometimes they sign in and then ask the nurses to enter the orders. Other times they ask the nurses to put the orders in verbally and then they confirm the orders. The nurses feel caught between the hospital’s goals and the need to maintain a good working relationship with these physicians.
Identify issues that occurred during CPOE implementation, identify potential causes of such issues, and list specific recommendations, using evidence-based rational and research to resolve the identified issues prior to the next CPOE implementation.
Elaborate on a scripture reference related to the discussion content.
Discussion Thread: Case Study — Selection, Implementation, Delivery
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Discussion Thread: Case Study — Selection, Implementation, Delivery
Issues that occurred during CPOE implementation
Resistance from a few physicians. By manipulating the system and pressuring the nurses to enter orders on their behalf, three physicians oppose the introduction of CPOE. This conduct undercuts the hospital's intention to use the CPOE system to enhance treatment experience and safety (Khaja, 2022). Some doctors' opposition to the CPOE procedure led to using non-activated units, verbal directives, and requesting that nurses write instructions on their accounts.
Lack of clear communication. Please clearly communicate and inform people more about the new system, which raises suspicion and non-compliance. The hospital needed to adequately inform all of the doctors and nurses who were involved with the implementation of the benefits of implementing CPOE and the hazards associated with not doing so.
Needs to be adequate training. It is possible that inadequate training on utilizing the CPOE system contributed to the physicians' resistance to the deployment.
Potential causes of such issues
Lack of buy-in from physicians. Doctors may need to fully understand the advantages of adopting the CPOE system and how it can enhance health outcomes and protection. They might therefore object if it is put into practice.
Resistance to change. Doctors needed to be more involved and engaged in the implementation process, which caused resistance and non-compliance. Some doctors dislike changing their established workflows and procedures, making them reluctant to use the CPOE system (Kluge, 2020).
Needs to be adequate training. Doctors who have not received enough training might find it difficult to use the CPOE system. Medical professionals and nurses need m...
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