The hospital that I work at is converting over to computerized physician order entry, and I am now wondering exactly what will the pharmacists do? They enter and veryify orders about 90% of the day. Are they just going to look at an order and hit verify? I honestly don't know what they are going to be doing and if we are really going to need all of them.
CPOE is a good thing. Yes, pharmacist will verify and hopefully will have more time now to make more clinical interventions. This will result in better patient care and reduce drug related adverse reactions and medication errors.
It has the potential to improve patient safety, but until all of the kinks are worked out, there is ample opportunity to create more problems than there are without it, which can worsen patient safety. Plus, CPOE is sometimes met with a lot of resistance. It takes time to learn new systems, which initially slows the flow of things. People get comfortable with the "old way," even if ultimately becoming more technologically advanced can make processes more efficient. What *should* occur is less frequent incorrect medications dispensed, since there no reason for illegible handwriting. Verification of orders is necessary, obviously, but there is still room for therapeutic interventions. I can go on and on and on about CPOE all night. Plus, there is literature out the wazoo on it.
Please do! I haven't worked much with it yet and what I hear scares me a little. Then again, we do technician order entry as well and that might scare me a little more. If nothing else I can see the wrong dosage form or strength getting picked all of the time. Lots of places that I'm applying to have CPOE. I might be the only weirdo in the world who LIKES order entry.
OHSU has a lot of good information on CPOE. The Leapfrog Group is another good source, especially regarding patient safety.
Look at it this way. With CPOE, Formulary and protocols can be tightly controlled since physicians only see what's on the CPOE. Ex. Physician wants to prescribe Nexium and scrolls and finds it only to inform them generic Omeprazole will be dispensed instead. Beautiful!
Well, if you have 300 different heparin strengths, then it's time to review that formulary and bring it down to 5. Emergency drugs for stat should be stocked in patient care area where nurses can override to have access.
We are in the process of narrowing down our heparin selection. I'm trying to think of a true "stat" we've had that wasn't something in the accudose- we don't let nurses mix electrolytes on the floor which is one of the only instances I can think of.
Well, you have some electrolytes in the Crash Cart...Calciums.. but you can have premixed KCL PiggyBags in the Accudose.. The true stat items should be in the Crash Cart Tray.
What is physician sentiment like when CPOE rolls in? I've never been around a hospital when they were transitioning. My experience has been with facilities that had had it for quite some time (and it ran flawlessly), or ones that wouldn't be considering it for quite a while.
This is the wave of the future. It will become the standard. For Medicare, physicians are going to be pushed into e-prescribing. If they don't do it within a couple of years, they'll be penalized.
Most people don't like changes. Everyone bitches about everything. But someone has to make the decision to put everyone on the progress train to the future.
That's what I figured. Because everyone loves it eventually...just takes them a little while to come around. Newer generation of prescribers...it will come naturally. Hospitals you deal with...70/30 use it? 80/20? More or less?
I suppose that is what I was referring to with it being met with resistance. People instinctively do not like change.
One potential disadvantage could be prescribers, and even pharmacists, becoming too reliant on these programs when they include decision support systems.
pharmacists have to be very careful about verifying...I've noticed residents click on the name "close enough" sometimes when they get frustrated with the system. For example, last week I saw physostigmine for a UTI. The doc obviously meant phenazopyridine but it's just something to look out for. It really does make things a lot easier for all parties involved for many many reasons
Yep. This can occur when people are in a rush and click the wrong med in a drop-down menu, for instance. Also, the feature that is found with a lot of computer programs allows for data to be filled in by just typing the first 2 or 3 letters (lisinopril, Lipitor, lithium, etc.). It's always good to have multiple eyes on the orders.
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We have CPOE and I really like it. Our staffing pharmacists do a lot of clinical work (vanco/AG consults, warfarin education, therapeutic drug reviews for dig/metformin/Ace-I) so CPOE has allowed them to spend more time on these other tasks. The pharmacists also get a print out of all their patients on Abx and they will review them and see if they are on the correct dose or if the abx are still needed. I think CPOE is an excellent thing for pharmacists because it will allow them to be more autonomous. As was mentioned though, it may lead to errors in prescribing. I've seen residents input the wrong drugs. One good thing with our system is that it has a range of doses and has a list of the most commonly prescribed doses which helps them so they don't select crazy doses that don't exist. Overall I like it and it is the wave of the future.
Think you're right. But if I remember correctly, it can't be edited at all? I think that was one of the trade offs. I spoke to one of the head designers/engineers for their program few years ago on a rotation in DC. Fascinating guy...and groundbreaking system he put out.
The hospitals that have CPOE do not have any less (or maybe a few less) pharmacists than those who dont. A pharmacist still has to verify, and CPOE brings in its own set of problems. It gives the pharmacists more time to think about the order rather than flying through all of them to get them all done.
