Refining Computerized Physician Order Entry Initiatives in an Adult Intensive Care Unit

Refining Computerized Physician Order Entry Initiatives in an Adult Intensive Care Unit by Chevita Fuller MSN, Walden University, 2010 BSN, Macon State College, 2005 Project Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Nursing Practice Walden University September 2014 Abstract Computerized physician order entry (CPOE) is used in healthcare organizations to improve workflow processes and transcription, as well as to prevent prescribing errors. Previous research has indicated challenges associated with CPOE for end-users that predispose patients to unsafe practices. Unsafe CPOE practices can be detrimental within the intensive care unit (ICU) setting due to the complexity of nursing care. Consequently,Computerized physician order entry (CPOE) is used in healthcare organizations to improve workflow processes and transcription, as well as to prevent prescribing errors. Previous research has indicated challenges associated with CPOE for end-users that predispose patients to unsafe practices. Unsafe CPOE practices can be detrimental within the intensive care unit (ICU) setting due to the complexity of nursing care. Consequently, end-user satisfaction and understanding of CPOE and electronic health record (EHR) functionality are vital to avoid error omissions. CPOE initiatives should be refined post system implementation to improve clinical workflow, medication processes, and end-user satisfaction. The purpose of this quality improvement project was to refine CPOE system initiatives and develop an e-learning educational module to facilitate end-user understanding of and satisfaction with CPOE. The Iowa model of evidence-based practice, Lean methodology, and Provider Order Entry User Satisfaction and Usage Survey (POESUS) were used to guide the study. An e-learning module was implemented to increase staff understanding of the newly implemented CPOE system, and a plan was provided for ongoing data collection and investigation of end-user satisfaction and medication inadequacies with the CPOE system. A mixed-method design was recommended to key stakeholders to identify the impact of the e-learning course and refined CPOE initiatives on both end-user satisfaction and patient outcomes in the medical-surgical ICU. Findings from the study informed the impact of e-learning educational modules with CPOE system implementation. Those in organizations implementing advanced technology such as CPOE and EHR systems in critical care settings will find this paper of interest. Refining Computerized Physician Order Entry Initiatives in an Adult Intensive Care Unit by Chevita Fuller MSN, Walden University, 2010 BSN, Macon State College, 2005 Project Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Nursing Practice Walden University August 2014 Dedication This project is dedicated to my earthly confidant and high-school sweetheart, Keat Fuller. Thank you for being a devoted husband and father, and most importantly, a genuine friend. You have been there during the most challenging and defying moments in my life, and your continued words of encouragement and adoration does not go unnoticed. Words cannot express my gratitude for your unwavering support and listening ear during the many callings placed upon my life. I could not have asked for anyone greater to share my life with ... the saga continues! Acknowledgments To my children, Darius, K’vian, and Keona, your existence, love, and admiration has been the foundation of my future ... you all are a true blessing from God, and without each of you providing your own unique petitions, I would not have the drive and ambition to press forward or pursue my dreams. Your existence has granted favor in my life. I love you! To my mother, Arma, thank you for instilling prayer and the word of God ... my spiritual faith and guidance have served me well. I would like to express my appreciation and heartfelt thanks to my mentor, Dr. Hartley. Thank you for guiding my research and allowing me to grow as a doctorial professional under your leadership and guidance, which are built upon a foundation of excellence. Your commitment and dedication to excellence do not go unnoticed. You definitely have a true calling, and I commend your perseverance and leadership. I would also like to thank my project chair, Dr. Mercy Popoola, and my committee members, Dr. Mary Verklan and Dr. Andrea Jennings, for your support, time, and guidance with the DNP project. To Walden’s entire DNP staff, thank you for leading a DNP program that is dedicated to social change and a culture of excellence. Above all, I would like to give thanks to my Heavenly Father for leading, guiding, and directing my path when I thought the possible was impossible. My spiritual guidance and “mustard seed” faith have kept me grounded and gave me a reason to press forward during the many oppositions of life ... He saw the best in me!