Promotion of Patient Safety Through Hospitalbased Systems Improvement: Advancement of Health Informa

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Promotion of Patient Safety Through
Hospital-based Systems Improvement
Advancement of Health Information
TechnologyMay 2005
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Computerized Physician Order Entry CPOE
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Determine and Present the Context for Change

• What is the imperative for change?
• Who needs to be involved in the change process?
• What are the resources for change?
• Organizational Change Primer
• Veterans Administration (VA) Office of Research
  and Development

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The Purpose of Change

• All health care organizations, professional
  groups, and private and public purchasers should
  adopt as their explicit purpose to continually
  reduce the burden of illness, injury, and
  disability, and to improve the health and
  functioning of the people of the United States.
• - Institute of Medicine, Crossing the Quality
  Chasm

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What are the Imperatives for Change?

• CPOE technology is a tool to
• Reduce medication errors,
• Reduce adverse drug reactions,
• Promote Patient Safety, and
• Promote best practices, and evidence-based
  medicine.

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CPOE in Action

• CPOE changes the work processes of physicians
• Electronic orders replace handwritten and verbal
  orders

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Who Needs to be Involved in the Change?

• Process owners involved in physician ordering and
  completion of orders
• Physicians
• Nursing
• Ancillary staff
• Pharmacy
• IT staff
• Administration
• Support staff

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What are the Resources for Change?

• Financial outlay
• Personnel time
• Training
• Education and publicity efforts
• Ongoing maintenance of effort

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Develop a Motivating Vision

• CPOE is a tool that improves patient safety and
  improves compliance with best practices and
  evidence-based medicine

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Key Lesson for Successful CPOE Implementation

• Hospital personnel must educate physicians about
  the patient safety benefits of CPOE and promote
  the technology as a patient safety initiative

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CPOE Improves Patient Safety

• Simplifies and standardizes work processes
• Decreases reliance on vigilance and human
  memory
• Increases availability of patient-specific and
  drug-specific information at the point-of-service
• Reduces errors in dose calculations and
  administration of medications to patients with
  known allergies
• Reduces medication errors and adverse drug events
  (ADEs)

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Increases Physician Satisfaction

• Promotes the health and well-being of their
  patients
• Decreases medical errors and exposure to
  malpractice claims
• Augments physician education, experience, and
  judgment
• Promotes work efficiencies
• Decreases stress related to reliance on human
  memory

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Clinical Decision Support System (CDSS) Advances
Best Practices and Evidence-Based Medicine

• Incorporates electronic order sets and computer
  logic allowing physicians to select medications,
  tests, and care modalities that result in
  improved care processes and patient outcomes
• Decreases unnecessary variation and standardizes
  best practices of patient evaluation and care

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Build Support for Change

• Administrative leadership is vital to success
• The personnel who perform the work involved in
  the physician ordering system are the only
  individuals with intimate process knowledge, and
  the only individuals who can adopt and perform
  the new processes
• Team members from all departments involved in the
  physician ordering system should be recruited

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Build Support for Change

• Begin with hospital leaders and other core
  believers
• Include members who are reluctant to change and
  who are not technologically savvy

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Key Lesson for Successful CPOE Implementation

• Physician ownership and leadership is necessary
  throughout the change process
• Physician ownership and leadership must be
  present at the beginning of a CPOE project

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Key Roles for Physician Leaders

• Physician advisory group
• Physician champions
• Physician executives

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Articulate Clear, Specific, and Realistic Goals
and Strategies
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Practical Steps for Change

• Select and recruit those who will perform the
  change work
• Understand and define current processes
• Define new processes
• Develop and adopt order sets

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Practical Steps for Change

• Plan for pilot and rollout
• Plan and complete education and training
• Plan and complete data collection and display
• Communicate clearly and frequently

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Strategies for Design, Training, and
Implementation

• Schedule site visits to hospitals already using
  CPOE
• Design a system that optimizes physician workflow
• Incorporate order sets that guide providers to
  best practices and evidence-based medicine
• Provide training in a variety of locations
• Organize the CPRS interface like a traditional
  paper chart
• computerized patient record system

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Strategies for Design, Training, and
Implementation

• Provide continuous support during rollout
• Provide adequate work stations, including
  laptops, wireless access, and remote access
• Incorporate order sets that guide providers to
  best practices and evidence-based medicine
• Provide a clinical Help Desk
• Update and use training modules for new
  physicians
• Include CPOE training in the credentialing
  process of new physicians

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Develop and Adopt Order Sets

• Order sets are a key to physician use of CPOE
• Order sets create efficiencies and optimize work
  flow
• Departmental orders promote collaboration, best
  practices, and evidence-based medicine

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Plan for Pilot and Rollout

• Some hospitals begin with electronic signatures
  and lab retrieval
• Pilots fine tune the system
• Rollout can be unit by unit or universal

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Data Collection and Feedback

• Measure and display patient safety and quality
  improvement benefits
• Measure and display physician adherence to order
  sets and best practices

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Communicate Clearly and Frequently

• Utilize newsletters and bulletin boards
• Create posters, buttons, and displays
• Communicate during meetings and special venues
• Communicate with patients and the public

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Identify Barriers to Change Develop Strategies
to Overcome Them

• Fear and inertia
• Wait and see individuals
• Core resisters
• Workarounds

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Recognize Participants

• Recognition can take many forms
• Bonuses and promotions
• Praise and personal recognition
• Awards and public recognition

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Look for the Early Win

• Data collection and display to staff
• Staff surveys
• Stories of local success can portray the value of
  change (following confidentiality guidelines and
  HIPAA regulations)