The document discusses Computerized Physician Order Entry (CPOE) systems, which allow physicians to directly enter medical orders like medications, tests, and procedures into a hospital's information system. CPOE provides benefits like real-time access to patient records, clinical decision support, and elimination of transcription errors. However, successful implementation requires addressing legal/ethical issues and gaining physician acceptance. Nurses will need new competencies and responsibilities in utilizing CPOE, such as entering orders and updating patient information.

1. Presented by Renae Foor

2. 1. Define Computerized Physician Order Entry
System
2. Describe hardware/software
3. Review the information system
4. Assess nursing implications
5. Examine related legal/ethical issues
6. Advantages/Disadvantages from nursing
perspective

3. What is CPOE?
Computer
Physician Order
Entry is software
that allows
physicians to
directly enter
their medical
orders into a
hospital
information
system.
(Reider, 2003)

4. Medical orders include…
Medication
Laboratory tests
Radiological procedures
Surgical procedures
Dietary orders

5. Offers access to patient
records
Offers clinical decision
support

6. Eliminates illegible
handwriting
Real-time access to patient
records
Offers clinical decision
support
Avoids transcription errors
Speeds up response time
Improves accuracy and
completeness
(Zahn, Hicks, et al., 2006)

7. From a desktop computer
From a personal data
assistant
From other electronic
devices
(Zahn, Hicks, et al., 2006)

8. Lightweight, hand-held computer
used as an information organizer and
has communication abilities.
Keyboard or pen-based
Applications
a) Word processor
b) Spreadsheet
c) Calendar
d) Address book
Sends and receives
a) Faxes
b) Data
c) E-mail messages

9. Computer
Machine that stores and manipulates
data and programs.
• Hardware – physical body
• Software – application programs
a) Word processing
b) Spreadsheets
c) E-mail
d) Internet
e) Conferencing
(McGonigle & Mastrian, 2009)

10. The information,
such as physician
orders or test
results, is initially
entered into the
hospital database
where it is easily
accessed by
different specialized
departments.
(Reider, 2003)
How the
System
Works?

11. Easily Accessible
Channels user through a
series of questions
Unproblematic for
experienced and
inexperienced nurses
Tasks are completed with
accuracy
Tasks are completed
quickly
(Staggers, 2003)

12.  CPOE systems must intersect with HIS systems
like:
 McKesson HIS
a. Booking & pre-admission
b. Admission & registration
c. Bed assignment, transfer, & discharge
d. Charging & claim submission
e. Management & follow-up
f. Customer service
(McKesson, 2008)

13. Allow professionals’ entry and access to data in real
time to enhance quality of patient care
User involvement in all steps of the implementation
of design and evaluation
Value of issues such as culture, advancement, and
leadership for successful implementation
(Oroviogoicoechea, Elliot, & Watson, 2008)

14. Legal Issues
I. Physicians coercing nurses to enter
orders for them
II. Physicians leaving the floor to call in
telephone orders
III. Patient privacy and security
IV. Physician overrides/Medical
malpractice
V. Poor implementation
VI. Improper Use
VII. Deficient ergonomics

15. Exceptions to CPOE
1. Phone orders if no computer access
2. Emergency orders
3. Protocol orders
4. Verbal orders given during
procedures
5. Orders during computer system
downtime

16. Advantages of CPOE
1. Provides drug screening information
2. Helps prevent adverse drug effects
3. Improves quality of patient care
4. Reduces drug expenses
5. Provides predefined orders
6. Speeds up medication ordering
7. Easy accessibility to patient’s medical orders
8. Eliminates handwriting/transcription errors
9. Increases productivity and workflow
10. Provides decision support

17. Disadvantages of CPOE
1. Too much information/over-alerting
2. Physician non-acceptance
3. Integration/staff training
4. Installation costs
5. Intrusion of physician decision-making

18. Nursing Competencies
Nurses utilizing CPOE will need to:
a. Use the database applications to enter and retrieve
patient data/orders
b. Demonstrate basic technology skills (typing &
printing)
c. Use applications for structured data entry
d. Use the application to plan care for patients
e. Use networks to navigate systems
f. Operate peripheral devices (PDAs)

19. Nursing Functions/Responsibilities
1. Enter admission/discharge orders
2. Place medication and non-
medication orders
3. Place ordersets
4. Update allergy information
5. Resolve orders conflicts
6. Discontinue orders

20. To Review……..
CPOE:
1) Offers quick access to patient medication orders
2) Offers clinical decision support
3) Provides drug screening information
4) Helps prevent adverse drug effects
5) Improves quality of patient care
6) Allows real-time access to patient records
7) Improves accuracy and completeness of physician
orders

21. References
McGonigle, D. & Mastrian, K. ( 2009). Nursing informatics and the foundation of
knowledge. Boston: Jones & Bartlett Publishers.
McKesson. (2007). HealthQuest, Retrieved December 14, 2008 from
http://www.mckesson.com/en_us/McKesson.com/For+Healthcare+Providers/
Hospitals
Oroviogoicoechea, C., Elliott, B., & Watson, R. (2008). Review: Evaluating
Information Systems in Nursing. Journal of Clinical Nursing 17, 567-575.
Reider, J. (2003). Computerized Physician Order Entry: Has the Time Come?
Medscape General Medicine, 5(2).
Stagger, N. (2003). Human Factors: Imperative Concepts for Critical Care. AACN
Clinical Issues, 14(3), 310-319.
Zahn, C., Hicks, R.W., Blanchette, C.M., Keyes, M.A., & Cousins, D.D. (2006).
Potential Benefits and Problems With Computerized Prescriber. American
Journal of Health System-Pharmacy, 63(4), 353-358.