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Nursing medication administration and workflow using computerized physician order entry.

Dana Tschannen¹, Akkeneel Talsma, Nicholas Reinemeyer

¹University of Michigan School of Nursing, Ann Arbor, MI 48109, USA. djvs@umich.edu

Computers, Informatics, Nursing : CIN

|December 18, 2010

Summary

This summary is machine-generated.

Computerized physician order entry (CPOE) systems impact nursing workflow, increasing medication administration time and creating workflow barriers. Improvements are needed in medication reconciliation, communication, and CPOE practice standard evaluations.

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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.