Learning Objective #1: Describe what Denver Health Medical Center is doing to minimize medical errors related to provider order writing

Learning Objective #2: Determine the impact of new technology on nursing practice and patient outcomes

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Rational: Computerized Provider Order Entry (CPOE) was introduced to Denver Health Medical Center in June of 2003. The Medical Intensive Care Unit (MICU) was chosen as the pilot site for this program. CPOE enables physicians to enter patient orders in the computer instead of writing them on paper. This process is believed to improve patient safety by decreasing errors. A need was identified to understand the impact of CPOE on nursing practice highlighting strengths and limitations of the new system.

Methodology: A convenience sample of 10 nurses, 3 males and 7 females, was selected. Three open-ended questions were asked: how CPOE has changed practice in the unit, what can be changed about the system and what advice would be given to the next group of nurses to experience CPOE. Data were analyzed qualitatively by identifying categories and major domains. A matrix was developed to identify relationships between categories and domains. Three major domains described the impact of CPOE on nursing: 1) Beneficial Outcomes; 2) Educational Deficits; and 3) Patient Safety Concerns. Rigor of the study was addressed through member checking and peer debriefing and recording of a decision trail of the study process.

Findings: Beneficial Outcomes include fewer verbal orders, less clarification of physician handwriting and faster implementation of lab orders. Educational Deficits include order entry mistakes by physicians, slowing down of workflow due to related system problems. Patient safety concerns include “dropping off” of current orders, nurses spending less time in bedside care and more time on the computer.

Implications for Nursing: The findings demonstrate implications for continued implementation of CPOE on other units and increased and continued staff education. Identified was a need for nurses to master the system and check orders very carefully for errors. Further research on quality and outcomes is indicated.