Risk analysis and user satisfaction after implementation of computerized physician order entry in Dutch hospitals

Computerized physician order entry (CPOE) in hospitals is widely considered to be important for patient safety, but implementation is lagging behind and user satisfaction is often low. Risk analysis methods may improve the implementation process and thus user satisfaction. Objective The aim of our study was to determine the association of performing risk analysis with user satisfaction after implementation of CPOE. Setting All hospitals in the Netherlands.

A cross-sectional study using a questionnaire was performed. All Dutch hospital pharmacies were asked about the extent of implementation of CPOE in the hospitals they served, the performance of (retrospective or prospective) risk analysis and the satisfaction with CPOE of doctors, nurses and pharmacists. Only hospitals that had implemented inpatient CPOE on at least 70 % of the wards were included in the primary analysis.

The primary outcome measure was the proportion of hospital pharmacists with a satisfaction level of 4 or 5 (i.e. 'satisfied'). The secondary outcome measure was the proportion of medical doctors and nurses with a satisfaction level of 4 or 5 (i.e. satisfied). The main determinant was the performance of a formal method of prospective or retrospective risk analysis.

The questionnaire was sent to all 79 Dutch hospital pharmacies. Questionnaires were returned by 70 hospital pharmacies, serving 72 separate hospitals. In 40 hospitals the CPOE was implemented on at least 70 % of the wards. The association of risk analysis with the proportion of satisfied users was determined within this group of 40 hospitals. For hospital pharmacists we found that the performance of risk analysis showed a statistically non-significant trend towards an association with satisfaction [OR 3.3 (95 % CI 0.8-14.1)]. For medical doctors the performance of risk analysis was associated with satisfaction [OR 10.0 (95 % CI 1.8-56.0)]. Also a statistically non-significant trend towards an association with satisfaction was found for nurses [OR 4.5 (95 % CI 0.8-24.7)].

Although not statistically significant, the user satisfaction with CPOE seems to be associated with the performance of risk analysis during the implementation of CPOE. This suggests that the CPOE implementation process can be optimized by performing risk analysis before and/or after implementation.