Nursing medication administration and workflow using computerized physician order entry

Area of Science:

• Health Informatics
• Nursing Workflow Analysis
• Clinical Systems Implementation

Background:

• Computerized physician order entry (CPOE) benefits are known, but its effect on nursing workflow and error potential remains unclear.
• Understanding CPOE's impact on nursing is crucial for optimizing healthcare delivery and patient safety.

Purpose of the Study:

• To determine the impact of a computerized physician order entry system on nursing workflow.
• To identify specific challenges and areas for improvement in CPOE-integrated nursing practices.

Main Methods:

• Exploratory design involving direct observation of nurses administering medications.
• Data collection through observation (n=36 ICU, n=50 pediatric) and nurse interviews.
• Analysis of time spent on medication delivery and identification of workflow barriers.

Main Results:

• Medication administration time averaged 8.45 minutes in ICU and 9.93 minutes in pediatrics, with additional steps for pediatric patients.
• Frequent workflow barriers included system issues (e.g., medication reconciliation, long order sets), reduced healthcare team interaction, and increased informal communication.
• Pediatric medication delivery involved more steps, including patient/family communication, contributing to longer administration times.

Conclusions:

• Computerized physician order entry significantly impacts nursing workflow, necessitating workflow adjustments.
• Key areas for improvement include streamlining medication reconciliation, enhancing interprofessional communication, and evaluating CPOE's effect on practice standards.
• Optimizing CPOE integration requires addressing system inefficiencies and communication gaps to support nursing practice.