· Reflect on the four peer-reviewed articles you critically appraised in Module 4, related to your clinical topic of interest and PICOT. · Reflect on your current healthcare organization and think about potential opportunities for evidence-based change, using your topic of interest and PICOT as the basis for your reflection. · Consider the best method of disseminating the results of your presentation to an audience.  The Assignment: (Evidence-Based Project) Part 4: Recommending an Evidence-Based Practice Change Create an 8- to 9-slide  narrated PowerPoint presentation in which you do the following: · Briefly describe your healthcare organization, including its culture and readiness for change. (You may opt to keep various elements of this anonymous, such as your company name.) · Describe the current problem or opportunity for change. Include in this description the circumstances surrounding the need for change, the scope of the issue, the stakeholders involved, and the risks associated with change implementation in general. · Propose an evidence-based idea for a change in practice using an EBP approach to decision making. Note that you may find further research needs to be conducted if sufficient evidence is not discovered. · Describe your plan for knowledge transfer of this change, including knowledge creation, dissemination, and organizational adoption and implementation. · Explain how you would disseminate the results of your project to an audience. Provide a rationale for why you selected this dissemination strategy. · Describe the measurable outcomes you hope to achieve with the implementation of this evidence-based change. · Be sure to provide APA citations of the supporting evidence-based peer reviewed articles you selected to support your thinking. · Add a lessons learned section that includes the following: · A summary of the critical appraisal of the peer-reviewed articles you previously submitted · An explanation about what you learned from completing the Evaluation Table within the Critical Appraisal Tool Worksheet Template (1-3 slides) Zeinab Hazime Nurs 6052 10/16/2022 Evaluation Table Use this document to complete the evaluation table requirement of the Module 4 Assessment, Evidence-Based Project, Part 3A: Critical Appraisal of Research Full APA formatted citation of selected article. Article #1 Article #2 Article #3 Article #4 Abraham, J., Kitsiou, S., Meng, A., Burton, S., Vatani, H., & Kannampallil, T. (2020). Effects of CPOE-based medication ordering on outcomes: an overview of systematic reviews. BMJ Quality & Safety, 29(10), 1-2. Alanazi, A. (2020). The effect of computerized physician order entry on mortality rates in pediatric and neonatal care setting: Meta-analysis. Informatics in Medicine Unlocked, 19, 100308. https.

1. · Reflect on the four peer-reviewed articles you critically
appraised in Module 4, related to your clinical topic of interest
and PICOT.
· Reflect on your current healthcare organization and think
about potential opportunities for evidence-based change, using
your topic of interest and PICOT as the basis for your
reflection.
· Consider the best method of disseminating the results of your
presentation to an audience.
The Assignment: (Evidence-Based Project)
Part 4: Recommending an Evidence-Based Practice Change
Create an 8- to 9-slide
narrated PowerPoint presentation in which you do the
following:
· Briefly describe your healthcare organization, including its
culture and readiness for change. (You may opt to keep various
elements of this anonymous, such as your company name.)
· Describe the current problem or opportunity for change.
Include in this description the circumstances surrounding the
need for change, the scope of the issue, the stakeholders
involved, and the risks associated with change implementation
in general.
· Propose an evidence-based idea for a change in practice using
an EBP approach to decision making. Note that you may find
further research needs to be conducted if sufficient evidence is
not discovered.
· Describe your plan for knowledge transfer of this change,
including knowledge creation, dissemination, and organizational
adoption and implementation.
· Explain how you would disseminate the results of your project
to an audience. Provide a rationale for why you selected this
dissemination strategy.

2. · Describe the measurable outcomes you hope to achieve with
the implementation of this evidence-based change.
· Be sure to provide APA citations of the supporting evidence-
based peer reviewed articles you selected to support your
thinking.
· Add a lessons learned section that includes the following:
· A summary of the critical appraisal of the peer-reviewed
articles you previously submitted
· An explanation about what you learned from completing the
Evaluation Table within the Critical Appraisal Tool Worksheet
Template (1-3 slides)
Zeinab Hazime
Nurs 6052
10/16/2022
Evaluation Table
Use this document to complete the
evaluation table requirement of the Module 4
Assessment,
Evidence-Based Project, Part 3A: Critical Appraisal of
Research
Full
APA formatted citation of selected article.
Article #1
Article #2
Article #3
Article #4

3. Abraham, J., Kitsiou, S., Meng, A., Burton, S., Vatani, H., &
Kannampallil, T.
(2020). Effects of CPOE-based medication ordering on
outcomes: an overview of systematic reviews.
BMJ Quality & Safety, 29(10), 1-2.
Alanazi, A. (2020). The effect of computerized physician order
entry on mortality rates in pediatric and neonatal care setting:
Meta-analysis.
Informatics in Medicine
Unlocked, 19, 100308.
https://doi.org/10.1016/j.imu.2020.100308
Elshayib, M., & Pawola, L. (2020). Computerized provider
order entry–related medication errors among hospitalized
patients: An integrative review.
Health
Informatics Journal, 26(4), 2834-2859. DOI:
10.1177/1460458220941750
Srinivasamurthy, S. K., Ashokkumar, R., Kodidela, S., Howard,
S. C., Samer, C. F., &
Rao, U.S. C. (2021). A systematic review is the impact of
computerized physician
order entry (CPOE) on the incidence of chemotherapy-related
medication
errors.
European Journal of Clinical Pharmacology,
1-9.

4. https://doi.org/10.1007/s00228-021-03099-9
Evidence Level *
(I, II, or III)
I
I
I
I
Conceptual Framework
Describe the theoretical basis for the study (
If there is not one mentioned in the article,
say that here).**
None
None
CPOE-related MEs that resulted from sociotechnical systems–
related factors)
None
Design/Method
Describe the design and how the study was carried out (In
detail, including
inclusion/exclusion criteria).
Systematic review that involves the search for databases such as
EMBASE, MEDLINE, and CINAHL. The focus was to identify
published SRs from inception to 12th Feb, 2018. The inclusion
criteria was based on full text review of primary evaluation
research studies on medication ordering supported by the CPOE
integrated with or without CDS.
Systematic review using the English literature significant to the
effect of CPOE on the mortality rates. The inclusion criteria

5. were children of 0 to 18 years; CPOE compared to no CPOE,
randomized control or cohort, morality incidence, and the range
of publications. The exclusion criteria involved the descriptive
and non-English literature.
Systematic review search for databases like PubMed and Google
Scholar.
The inclusion criteria is that the CPOE-associated MEs helps in
the critical appraisal and summarizing the greater with text. The
studies must involve outpatients, must have evaluated problem
as opposed to the clinical or technical issue.
Systematic review search of four database from 1 January 1995
until August 2019. The English language studies assessing the
impact CPOE on CMEs were chosen as the inclusion and
exclusion criteria. Studies assessing several interventions with
no non-intervention groups were excluded.
Sample/Setting
The number and characteristics of
patients, attrition rate, etc.
No specific setting or sample since the study involved
systematic review (clinical setting, i.e. inpatient and outpatient
and the emergency department)
Systematic review methods with no sample.
None since they study involved a systemic review
The study was based on systematic review hence no sampling
was adopted.
Major Variables Studied
List and define dependent and independent variables
CPOE-Based approach as independent variable and medication
ordering as dependent variable
CPOE is the independent variable while the mortality rates in
the pediatric and neonatal care setting is the dependent variable.

6. CPOE is the independent variable while the medication errors
amongst hospitalized patients are the dependent variable.
The independent variable was the computerized physician order
entry (CPOE). The dependent variable was the rates of the
chemotherapy-associated medication errors that was impacted
on by the CPOE.
Measurement
Identify primary statistics used to answer clinical questions (
You need to list the actual tests done).
Data aggregated into figures and tables. Pooled summary
estimates 1 year lag time calculated the citation counts and
ratio. The Person correlation of citation counts computed using
the AMSTAR scores.
The meta-analysis performed using the coefficient interval (CI)
and the probability (P)
The meta-analysis procedures involve percentages and
probability was used.
Quality scores used to find out the overall applicability and the
effect of studies and to define the eligibility for meta-analysis.
Meta-analysis or the random effect model conduced to using R
statistical software. Variance estimation or tau-squared
performed for the distribution of the true impacts sizes
performed using the DerSimonian-Laird estimator.
Data Analysis Statistical or
Qualitative findings
(
You need to enter the actual numbers
determined by the statistical tests or qualitative data).
AMSTAR scores used to compute Pearson correlation citation
counts. Analysis performed using Excel 2016
Percentage, probabilities, and the coefficient interval.
Probability and percentages
The R-statistical software version 3.6.2 used to perform meta-

7. analysis. DerSimonian-Laird estimator.
Findings and Recommendations
General findings and recommendations of the research
CPOE resulted to the significant reduction in the medication
errors and the negative effects of the drug events.
The recommendation is that future studies need to consider the
definition of errors.
The future SRs and primary should focused on concerted efforts
of building a cumulative evidence on the effectiveness of the
CPOE outcomes.
CPOE has the ability to offer guidance to physicians. More
studies are needed.
The interplay that occurs between social and technical aspect is
greatly impacting on safe implementation and use. It influences
the development of the suitable strategies for the safe and
effective CPOE.
The recommendation for future research and the new HIT
projects is that the organizational leadership must acknowledge
the technical abilities along towards implementing safer HIT.
The assessment of the sociotechnical factors by use of the eight-
dimensional model contributes to safe and effective CPOE
implementation. This makes it possible to address the readiness
of implementing the CPOE by evaluating the internal culture
and development of the policies and procedures that is
consistent with the clinical workflow in the presence of change
in consideration.
There is a consistent decrease in CMEs following the CPOE
implementation except for one study that revealed an increase in
CME. The recommendation is that the external validity of the
studies needs to be gauged since they use different CPOE
systems and in diverse settings.
Appraisal and Study Quality
Describe the general worth of this research to practice.

8. What are the strengths and limitations of study?
What are the risks associated with implementation of the
suggested practices or processes detailed in the research?
What is the feasibility of use in your practice?
The study is important for the capstone project since it shows
the impact of CPOE-based medication ordering on safety and
the clinical outcomes.
The limitation of the study is that the evaluation of the SRs in
the overview of SRs was limited by the reporting features of the
included SRs. There is also heterogeneity across SRs and which
limits the ability to come up with the generalize observations
concerning the effectiveness of the CPOE use.
Based on this study, CPOE is somehow not directly linked to
the drop in the medication errors.
The study is important for the capstone project as it confirms
the effect of the CPOE in the reduction of mortality rates.
The limitation of the study is related to the number of available
studies.
The study is feasible since CPOE can be implemented to assists
in the physician order entry on mortality. The CPOE has the
potential to help in the reduction of mortality and improving
then prescription process by offering guidance to providers.
The implementation of the CPOE helps in the reduction of the
medication errors amongst hospitalized clients.
There is no mentioning of the limitation and strengths of the
study.
The feasibility of this study is that it offers solution to
addressing the issue of medication errors amongst hospitalized
clients.
The study is important for the capstone as it reveals how CPOEs
impacts on the rates of the chemotherapy associated medication
errors. The strength of the study is that studies were taken from
different parts of the world thus making it possible to generalize
and apply the study. Most of the studies included were single

9. center studies. The limitation of the study is all studies used
different CPOE systems and in diverse settings.
The risk of the study is that there can be improper preparation
and the acclimatization this leading to the rise in CME.
The feasibility of the study is that CPOE implementation
requires multidisciplinary strategy to train and acclimate.
Key findings
There is no significant relative risk decrease on the hospital
mortality or the number of days spent in the facilities.
CPOE has the ability to offer guidance to physicians. More
studies are needed.
The successful identification of the major categories of the
CPOE-associated unintended impacts and handling their causes
result in the development of the suitable approaches for safer
and successful CPOEs.
CPOE positively impacts on the chemotherapy-associated
medication errors.
Outcomes
Pooled studies reveal CPOE use leads to the greater reduction in
medication errors and the adverse effects of the medication
errors.
Five cohort studies met the inclusion criteria. Two studies
occurred at the pediatric wards and three at PICUs and or
NCUS. The analysis reveal a reduction in mortality rate upon
implementation of the CPOE.
The interplay between the technical and social factors greatly
impact on the execution and use.
There is a consistent reduction of the CME with implementation
of the CPOEs.
General Notes/Comments
The study is important as it informs about the widespread
adoption of CPOEs across world. The overview helps in
facilitating evidence-driven decision-making on the future.

10. The positive effects of the CPOEs leads to the successful
detection and prevention of errors.
The CPOEs and tackling the sociotechnical aspect affects the
safety of the CPOEs. This is an important approach in
improving the effectiveness and safety of CPOEs in the context
of the sociotechnical aspects.
The adoption and implementation of the CPOE helps in the
reduction of CMEs by 81 percent.
Part B
The best practice that emerged from the research review is the
computerized physician order entry (CPOE) system which helps
reduce medication errors compared to the paper-based system.
According to the results from the systematic review method
adopted by the articles, medication errors are preventable.
Nevertheless, the lack or poor implementation of the available
interventions, such as CPOE, adversely affects the overall
outcomes of the patients. The poor implementation practices
increase the reported incidences of medication errors (Abraham
et al., 2020). Individuals report an extended stay in the hospital
as a result of diagnosis with new infections and readmission.
Parents of pediatric patients also encounter high medical costs
and risk of exposure to preventable nosocomial diseases. The
outcomes also impact the providers and organization, leading to
low performance in pediatric units. This impacts the hospital's
quality performance per the Center of Medicare Services (CME)
ranking.
The utilization of the CPOE results in reduced medication errors
and negative effects of medication errors. The practice leads to
a decrease in the reported mortality rates, and the
implementation process requires the interplay between the
technical and social aspects that positively influence its
implementation and use. Implementing the CPOE leads to a

11. consistent drop in chemotherapy-associated medication errors.
The findings from the study also reveal that the CPOE can
ensure that the providers have access to the guidelines regarding
medication error reductions. The effective approaches in
identifying the major concepts of the CPOE-related unintended
effects and addressing their causes lead to developing the
appropriate strategies for the safe and successful
implementation of the CPOEs (Alanazi, 2020). The use of the
CPOE is positively impacting chemotherapy-related medication
errors. The study outcomes confirm the importance of CPOE
adoption and implementation to reduce the reported cases of
medication errors within the pediatric units. Therefore, CPOE-
based drug ordering has positive effects in terms of safety and
patients.
References
Abraham, J., Kitsiou, S., Meng, A., Burton, S., Vatani, H., &
Kannampallil, T. (2020). Effects of CPOE-based medication
ordering on outcomes: an overview of systematic reviews. BMJ
Quality & Safety, 29(10), 1-2.
Alanazi, A. (2020). The effect of computerized physician order
entry on mortality rates in pediatric and neonatal care setting:
Meta-analysis. Informatics in Medicine Unlocked, 19, 100308.
https://doi.org/10.1016/j.imu.2020.100308
Elshayib, M., & Pawola, L. (2020). Computerized provider
order entry–related medication errors among hospitalized
patients: An integrative review. Health Informatics Journal,
26(4), 2834-2859. DOI: 10.1177/1460458220941750
Srinivasamurthy, S. K., Ashokkumar, R., Kodidela, S., Howard,
S. C., Samer, C. F., & Rao, U.S. C. (2021). A systematic review
is the impact of computerized physician order entry (CPOE) on
the incidence of chemotherapy-related medication errors.
European Journal of Clinical Pharmacology, 1-9.

12. https://doi.org/10.1007/s00228-021-03099-9
Critical Appraisal Tool Worksheet Template
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