Learning Objective #1: Gain an understanding of electronic order entry implementation process and its impact on clinical practice

Learning Objective #2: Increase their knowledge of policy and process changes necessary for electronic order entry

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Introduction: Electronic order entry is one of the first steps towards building a fully electronic patient record. At Mount Sinai Hospital, the integration of electronic order entry (OE), electronic medication administration record (EMAR) and pharmacy system, presents significant challenges as well as opportunities to clinicians and administrators, involved in the implementation of a new system. To facilitate meaningful changes to the communication and coordination of patient care processes, when electronic order entry is being implemented, requires thoughtful analysis of current practice patterns and policies.

A needs assessment of the Mount Sinai Hospital order entry project identified approximately 60 process changes requiring policies and procedures. A Policy and Procedures Working Group was established to provide efficient and effective approval of all policies created for the order entry system. Using a systems approach, the Working Group moved quickly to assemble evidence, facts, what technology can or cannot do as key inputs. Within the systems framework, involving everyone makes it an iterative process. Having a body of experts that are willing to gather information, review evidence and provide critical appraisal is invaluable.

Policies that take into account who enter orders into the systems, how the system handles different types of orders, and how to alert clinicians of new and stat orders were created. The outcome of developing supportive policies and procedures facilitates better understanding and management of the change. It also led to improvements to clinician workflow and enhancements to patient care.

Conclusion: Implementation of electronic order entry requires leadership from all levels in the organization. Nurses who are leading technological changes must develop strategies and advocate for policy changes to address the challenges to system implementation. Policies aimed at improving the overall safety of patient care creates a culture of safety, enhances care processes and supports clinical practice.