Building Customized Clinical Pathway Order Sets for CPOE Implementation

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Implementing the Order Entry Component of an Existing Emergency Department Electronic Documentation System

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Building Customized Clinical Pathway Order Sets for CPOE Implementation

  1. 1. Building Customized Clinical Pathway Order Sets Implementing the Order Entry Component of an Existing Emergency Department Electronic Documentation System<br />Anna M. Rogers, MSN, RN<br />
  2. 2. Develop fully operational <br />and customized<br />Clinical Pathways Order Sets (CPOS) that replace handwritten order sheets in the ED.<br />Project Goal<br />
  3. 3. The Problem With Paper Orders<br /><ul><li>Medical errors and waste.
  4. 4. Illegible, incomplete, not </li></ul>clinically indicated and duplicate orders.<br /><ul><li>Limits communication to paper, verbal, phone, pager - and even by assumption!</li></li></ul><li>Paper Chart Workflow<br />How do we ever get anything done?<br />Too many variables!<br />Messy!<br />Unpredictable!<br />Where is that chart?<br />
  5. 5. Why Order Entry?<br />Impact on patient safety:<br /> Medication errors<br />Ambiguity of orders<br />Omission/redundancy of orders<br />
  6. 6. Why Order Entry?<br />Impact on clinical decisions:<br />Best Practices and Standards of Care.<br /> Clinical Decision Support Service (CDSS)<br />
  7. 7. Project Objectives<br />Build CPOS using best practices and clinical standards<br />Include end users and stakeholders<br />CPOS in TEST site for clinician approval and practice<br />Training of end users<br />Evaluate training and OE acceptance by survey<br />Share survey results at wrap up<br />
  8. 8. CPOS sets<br />are named <br />for the<br />presenting problem.<br />*Screen shots used with permission from Picis, Inc. <br />
  9. 9. CPOS – how they look<br />Med orders on next screen<br />
  10. 10. Task Pane View<br />Completed orders indicate when they were done and by whom.<br />Incomplete orders contain a ‘Done’ and ‘Cancel’ button for the clinician to choose.<br />
  11. 11. Tracking Board - Communication<br />Red =order placed<br />Blue =order acknowledged<br />Purple =test completed or specimen obtained<br />Green =order completed or final results<br />All orders will show up in one of these columns:<br />X = diagnostic imaging<br />Y = diagnostic imaging tech<br />L = lab<br />T = ED tech<br />H = HUC<br />E = EKG<br />N = RN<br />M = medication<br />U = Urine specimen<br />
  12. 12. Improved Order Entry Workflow<br />
  13. 13. Order Entry: Evaluation<br /><ul><li> Surveys were distributed one week after go-live
  14. 14. Results presented at the Project Wrap-Up meeting</li></li></ul><li>
  15. 15.
  16. 16. Supported Clinicians <br />Provide Higher<br />Quality Care!<br />
  17. 17. Survey Part I – Training(NA = no answer)1. I practiced using Order Entry in the PulseCheck TEST site. Yes (9) No (7) NA (2)2. I attended a training session in the Computer Training Center. Yes (3) No (13) NA (2)3. I viewed the Order Entry tutorials available on the PulseCheck Login page. Yes (12) No (4) NA (2)<br />
  18. 18. Survey Part II – Application<br />
  19. 19. ConclusionsTrainingOf the eighteen surveys returned, training methods were regarded as neutral or positive. Most of the respondents utilized the TEST site and the training tutorials, while only three said they attended the hands on training. ApplicationMost respondents indicated acceptance of Order Entry with mostly positive or neutral answers. However, usage of the corresponding clinical pathways order sets for each patient indicates that they may not be fully utilized (8 neutral or agree, 10 disagree or did not answer). Most of the responding nurses who did not answer or disagreed because they thought that the order sets were for physician use only. The negative answers regarding usefulness (safety, communication, etc.) of the application warrant some concern if they are from those who carry influence among their peers, which could jeopardize the continued successfulness of Order Entry. <br />
  20. 20. References<br />Farrell, A. (2008, Nov. 13). Preparing for clinical documentation: A strategic view [webinar]. Healthcare Information and Management Systems Society (HIMSS). Retrieved from http://www.himss.org<br />Lee, P. D., and Hirshfield, M. (2006). Project planning for healthcare. The Health Care Manager, 25 (4), 310-314.<br />Mewshaw, M. R., White, K. M., and Walrath, J. (2006, October). Medical errors: Where are we now? Nursing Management, 37(10), pp. 50–54.<br />Piechowski, R. (2006). Making CPOE work: Redesign workflows to optimize benefits. Patient Safety & Quality Healthcare, March/April. Retrieved from http://www.psqh.com/marapr06/cpoe.html<br />Sengstack, P. P. and Gugerty, B. (2004, Winter). CPOE systems: Success factors and implementation issues. Journal of Healthcare Information Management, 18 (1), pp. 36-45.<br />
  21. 21. References (cont.)<br />The Standish Group Report. (2006). Chaos. Retrieved from http://www.cs.nmt.edu/~cs328/reading/Standish.pdf <br />U. S. Department of Health and Human Services (HHS). (2006). HHS strategic plan: Fiscal years 2007–2012.Retrieved from http://www.hhs.gov<br />Wang, X. S., Nayda, L. and Dettinger, R. (2007). Infrastructure for a clinical decision-intelligence system. IBM Systems Journal, 46 (1), pp. 151-169.<br />

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