DNP 805 Topic 3 DQ 1 Describe how CPOE and CDSS embedded in the EHR can be useful towards a specific patient population of your choice

DNP 805 Topic 3 DQ 1 Describe how CPOE and CDSS embedded in the EHR can be useful towards a specific patient population of your choice

DNP 805 Topic 3 DQ 1 Describe how CPOE and CDSS embedded in the EHR can be useful towards a specific patient population of your choice

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Topic 3 DQ 1

Apr 28-30, 2022

Describe how CPOE and CDSS embedded in the EHR can be useful towards a specific patient population of your choice. Identify one element of either the CPOE or CDSS you would improve that could enhance the effectiveness of the system for that patient population.

REPLY TO DISCUSSION

The use of computerized provider order entry (CPOE) and clinical decision support systems (CDSS) have greatly impacted the healthcare system. In comparison to the previous workflow where providers would have to physically handwrite orders or provide telephone orders, they can now easily enter their orders electronically. This is beneficial for all patient populations, especially adults who are admitted to the intensive care units (ICU). CPOE has contributed to patient safety in the ICUs since orders are very specific. CPOE and CDSS have prevented medication errors by about 55% as the system is able to catch miscalculations ahead of time (Metcalfe et al., 2017). Having the ability of CPOE and CDSS in place has also prevented uncertainties caused by illegible handwriting, which has also led to errors and patient harm in the past. CPOE has also improved administration time as it has enabled for faster communication between other departments such as the laboratory and pharmacy (Abraham et al., 2020). CPOE and CDSS have also contributed to cost reduction as it helps eliminate duplicate and unnecessary orders. In my professional opinion, having order sets in place would be an advantage for ICU patients. Since patients in the ICU have high acuities and need more frequent attention, having order sets in place for the physicians may help speed the admission process. Order sets help by ensuring appropriate orders are in place, and none are missed (Abraham et al., 2020).

References

Abraham, J., Kitsiou, S., Meng, A., Burton, S., Vatani, H., & Kannampallil, T. (2020). Effects of CPOE-based medication ordering on outcomes: an overview of systematic reviews. BMJ Quality & Safety, 29(10), 1–2. https://doi-org.lopes.idm.oclc.org/10.1136/bmjqs-2019-010436

 

Metcalfe, J., Lam, A., Lam, S. S. H., Clifford, J. ‐ M., & Schramm, P. (2017). Impact of the introduction of computerized physician order entry ( CPOE) on the surveillance of restricted antimicrobials and compliance with policy. Journal of Pharmacy Practice & Research, 47(3), 200–206. https://doi-org.lopes.idm.oclc.org/10.1002/jppr.1227

REPLY

ICU is one of those areas that have many alerts, reminders, algorithms and the high risk of medication errors and alert fatigue. The constant alarms beeping whether monitors or pumps plus orders that have algorithms and values that must be checked prior to administering of specific drugs and window periods that must be observed. It is so heartwarming to see that systems are really in place to minimize errors in a population that is already compromised by nature of the events that contributed to their placement in ICU.

REPLY

Thank you for the post. I agree with all the advantages seen in using CPOE / CDSS in the different patient population, either in the acute setting or community setting. I think these innovation of technologies continue to progress and growth each day. As nurses need to communicate with the other members of the healthcare in order to ensure that those orders will really benefit our patients. We need to work hand on hand with these technologies and importantly, we anticipate and think critically with any situations that possibly change the system. Stay safe.

REPLY

Greetings Audimar! I agreed with you when you mentioned that CPOE has contributed to patient safety in the ICUs since orders are precise. CPOE can offer safety features such as allergy alerts, drug-drug, drug-food, and drug-disease interaction checks, suggest safe medication dose ranges and intervals, guide users in implementing clinical practice guidelines and care pathways, and embed reference material (Bartman et al., 2019).  In addition, CPOE can serve as a patient safety enhancer through medicinal error elimination as well as reduction. Moreover, CPOEs can prove crucial for efficiency when concerning the submission of radiology, and lab, alongside medication towards their respective facilities and/or departments (Bartman et al., 2019).  Likewise submitting medication, lab, and radiology orders to their respective departments or facilities.  Bartman et al. (2019) also concluded that policies were designed to increase flexibility and safety, led to an increased coordination load on the healthcare team, and created new sources of error.  However, one of the biggest challenges in implementing CPOE is that it can disrupt workflow for several reasons. The first one is training. The medical staff, including doctors, nurses, and pharmacists, must learn to use the system.

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Reference

Bartman, T., Bertoni, C. B., Merandi, J., Brady, M., & Bode, R. S. (2019).  Patient safety: what is working and why?. Current Treatment Options in Pediatrics, 5(2), 131-144.

REPLY

The office of the National Coordinator (ONC) for Health Information Technology defined clinical decision-support system (CDSS). It is a system that supports clinical decisions of health care practitioners, patients and other knowledgeable people to guide the clinical practice with filtered specific information to be presented at the right time to help improve the health of patients and to advance health care in general. This clinical decision support has a variety of tools which is used to improve decisions made in the clinical workflows. Some of the tools in CDSS are alerts and reminders that are computerized for the patients and clinicians, specific orders that are set to a specific condition, data reports that are focused on patients, supports with diagnostics and templates for documentations (Alexander, Hoy, & Frith, 2019). Computerized provider order entry (CPOE) is the process by which health care providers (HCP) enter and send orders and treatment instructions such as medications, laboratory, and radiology through the computer applications and not by using paper, fax, or telephone (HealtIT.gov., 2018).

The use of CDSS and CPOE that is embedded within the EHR can help to reduce errors, improve the efficiency and the safety of the care processes, increases consistency in decisions made thereby reducing increased variations which are used to provide care for the patients as well as improve the efficiency of reimbursements for care provided. It can also delay and hinder the delivery of care when the focus is on problems that lack importance and widening of digital inequalities. When the HCP enter orders into the computer, it interfaces with the EHR. It is analyzed and gives a clinical picture for the HCP of the situation of the patient. If it is abnormal, it triggers a parameter alert for the HCP to seek out the problem and perform an intervention (Alexander, Hoy, & Frith, 2019) (Mebrahtu, Skyrme, Randell, Keenan, Bloor, Yang, Andre, Ledward, King, & Thompson, 2021).

One of the tools that CDSS and CPOE is used in the cardiac patients is in the alerts that are used in the telemetry units for the heart monitors. When the patient is in distress when the vital signs are abnormal either too low or too high, the CDSS begins to alert to draw the attention of the HCP. This helps to monitor the patients and intervene promptly to prevent them from going into severe cardiac events.

One of the elements that I would like to improve would be when the monitors come off or when the patient is moving so much the alarm continues to beep. There is no distinction with the different alarms. The alarms all sound the same except when it is ventricular tachycardia or ventricular fibrillation. So, I would like to make different alarm sounds for each specific situation so that the HCP is not wandering what is causing the alarm and wasting time deciphering what is causing the alarm.

References:

Alexander, S., Hoy, H., & Frith, K. (2019). Applied clinical informatics for nurses (2nd ed.). Jones & Bartlett Learning.

HealtIT.gov. (2018, March 21). What is computerized provider order entry? | HealthIT.gov. ONC | Office of the National Coordinator for Health Information Technology. https://www.healthit.gov/faq/what-computerized-provider-order-entry

Mebrahtu, T. F., Skyrme, S., Randell, R., Keenan, A., Bloor, K., Yang, H., Andre, D., Ledward, A., King, H., & Thompson, C. (2021). Effects of computerized clinical decision support systems (CDSS) on nursing and allied health professional performance and patient outcomes: A systematic review of experimental and observational studies. BMJ Open, 11(12), e053886. https://doi.org/10.1136/bmjopen-2021-053886

REPLY

This is a great suggestion as the primacy of how health care facilities supervise alarms is one of the Safety goals of the Joint commission (Ruppel, 2018). Alarm fatigue can lead to persons not responding to the alarm when it goes and can overlook life-threatening changes in a patient’s condition so this is really a good idea. Thanks for sharing.

Hello C…,

Nice post and I agree with you that CDSS is one approach that has been utilized to enhance the suitability of medication orders in clients. Computerized clinical decision support systems (CDSSs) are designed to aid clinical decision-making using individual patient characteristics to generate health-related recommendations. Clinical decision support systems have been shown to improve patient outcomes in some circumstances. CDSS appear most likely to improve patient outcomes when used to help manage chronic conditions such as high cholesterol and diabetes. Such systems can improve blood glucose when implemented as part of a complex hospital-based intervention. CDSS may also reduce adverse events and mortality in inpatient care (Jia P, Zhang L, Chen J, Zhao P, Zhang M, 2016).

References

Jia P, Zhang L, Chen J, Zhao P, Zhang M. The effects of clinical decision support systems on medication safety: an overview. PLoS ONE. 2016;11(12): e0167683.

Important information for writing discussion questions and participation

Welcome to class

Hello class and welcome to the class and I will be your instructor for this course. This is a -week course and requires a lot of time commitment, organization, and a high level of dedication. Please use the class syllabus to guide you through all the assignments required for the course. I have also attached the classroom policies to this announcement to know your expectations for this course. Please review this document carefully and ask me any questions if you do. You could email me at any time or send me a message via the “message” icon in halo if you need to contact me. I check my email regularly, so you should get a response within 24 hours. If you have not heard from me within 24 hours and need to contact me urgently, please send a follow up text to

I strongly encourage that you do not wait until the very last minute to complete your assignments. Your assignments in weeks 4 and 5 require early planning as you would need to present a teaching plan and interview a community health provider. I advise you look at the requirements for these assignments at the beginning of the course and plan accordingly. I have posted the YouTube link that explains all the class assignments in detail. It is required that you watch this 32-minute video as the assignments from week 3 through 5 require that you follow the instructions to the letter to succeed. Failure to complete these assignments according to instructions might lead to a zero. After watching the video, please schedule a one-on-one with me to discuss your topic for your project by the second week of class. Use this link to schedule a 15-minute session. Please, call me at the time of your appointment on my number. Please note that I will NOT call you.

Please, be advised I do NOT accept any assignments by email. If you are having technical issues with uploading an assignment, contact the technical department and inform me of the issue. If you have any issues that would prevent you from getting your assignments to me by the deadline, please inform me to request a possible extension. Note that working fulltime or overtime is no excuse for late assignments. There is a 5%-point deduction for every day your assignment is late. This only applies to approved extensions. Late assignments will not be accepted.

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Plagiarism is highly prohibited. Please ensure you are citing your sources correctly using APA 7th edition. All assignments including discussion posts should be formatted in APA with the appropriate spacing, font, margin, and indents. Any papers not well formatted would be returned back to you, hence, I advise you review APA formatting style. I have attached a sample paper in APA format and will also post sample discussion responses in subsequent announcements.

Your initial discussion post should be a minimum of 200 words and response posts should be a minimum of 150 words. Be advised that I grade based on quality and not necessarily the number of words you post. A minimum of TWO references should be used for your initial post. For your response post, you do not need references as personal experiences would count as response posts. If you however cite anything from the literature for your response post, it is required that you cite your reference. You should include a minimum of THREE references for papers in this course. Please note that references should be no more than 5 years old except recommended as a resource for the class. Furthermore, for each discussion board question, you need ONE initial substantive response and TWO substantive responses to either your classmates or your instructor for a total of THREE responses. There are TWO discussion questions each week, hence, you need a total minimum of SIX discussion posts for each week. I usually post a discussion question each week. You could also respond to these as it would count towards your required SIX discussion posts for the week.

I understand this is a lot of information to cover in 5 weeks, however, the Bible says in Philippians 4:13 that we can do all things through Christ that strengthens us. Even in times like this, we are encouraged by God’s word that we have that ability in us to succeed with His strength. I pray that each and every one of you receives strength for this course and life generally as we navigate through this pandemic that is shaking our world today. Relax and enjoy the course!

Hi Class,

Please read through the following information on writing a Discussion question response and participation posts.

Contact me if you have any questions.

Important information on Writing a Discussion Question

• Your response needs to be a minimum of 150 words (not including your list of references)
• There needs to be at least TWO references with ONE being a peer reviewed professional journal article.
• Include in-text citations in your response
• Do not include quotes—instead summarize and paraphrase the information
• Follow APA-7th edition
• Points will be deducted if the above is not followed

Participation –replies to your classmates or instructor

• A minimum of 6 responses per week, on at least 3 days of the week.
• Each response needs at least ONE reference with citations—best if it is a peer reviewed journal article
• Each response needs to be at least 75 words in length (does not include your list of references)
• Responses need to be substantive by bringing information to the discussion or further enhance the discussion. Responses of “I agree” or “great post” does not count for the word count.
• Follow APA 7th edition
• Points will be deducted if the above is not followed

• Remember to use and follow APA-7th edition for all weekly assignments, discussion questions, and participation points.
• Here are some helpful links
• Student paper example
• Citing Sources
• The Writing Center is a great resource

Unread
Replies to Audimar Bugayong
The office of the National Coordinator (ONC) for Health Information Technology defined clinical
decision-support system (CDSS). It is a system that supports clinical decisions of health care
practitioners, patients and other knowledgeable people to guide the clinical practice with filtered
specific information to be presented at the right time to help improve the health of patients and to
advance health care in general. This clinical decision support has a variety of tools which is used to
improve decisions made in the clinical workflows. Some of the tools in CDSS are alerts and reminders

that are computerized for the patients and clinicians, specific orders that are set to a specific condition,
data reports that are focused on patients, supports with diagnostics and templates for documentations
(Alexander, Hoy, & Frith, 2019). Computerized provider order entry (CPOE) is the process by which
health care providers (HCP) enter and send orders and treatment instructions such as medications,
laboratory, and radiology through the computer applications and not by using paper, fax, or telephone
(HealtIT.gov., 2018).
The use of CDSS and CPOE that is embedded within the EHR can help to reduce errors, improve the
efficiency and the safety of the care processes, increases consistency in decisions made thereby
reducing increased variations which are used to provide care for the patients as well as improve the
efficiency of reimbursements for care provided. It can also delay and hinder the delivery of care when
the focus is on problems that lack importance and widening of digital inequalities. When the HCP enter
orders into the computer, it interfaces with the EHR. It is analyzed and gives a clinical picture for the HCP
of the situation of the patient. If it is abnormal, it triggers a parameter alert for the HCP to seek out the
problem and perform an intervention (Alexander, Hoy, & Frith, 2019) (Mebrahtu, Skyrme, Randell,
Keenan, Bloor, Yang, Andre, Ledward, King, & Thompson, 2021).
One of the tools that CDSS and CPOE is used in the cardiac patients is in the alerts that are used in the
telemetry units for the heart monitors. When the patient is in distress when the vital signs are abnormal
either too low or too high, the CDSS begins to alert to draw the attention of the HCP. This helps to
monitor the patients and intervene promptly to prevent them from going into severe cardiac events.
One of the elements that I would like to improve would be when the monitors come off or when the
patient is moving so much the alarm continues to beep. There is no distinction with the different alarms.
The alarms all sound the same except when it is ventricular tachycardia or ventricular fibrillation. So, I
would like to make different alarm sounds for each specific situation so that the HCP is not wandering
what is causing the alarm and wasting time deciphering what is causing the alarm.
References:
Alexander, S., Hoy, H., & Frith, K. (2019). Applied clinical informatics for nurses (2nd ed.). Jones &
Bartlett Learning.
HealtIT.gov. (2018, March 21). What is computerized provider order entry? | HealthIT.gov. ONC | Office
of the National Coordinator for Health Information Technology. https://www.healthit.gov/faq/what-
computerized-provider-order-entry
Mebrahtu, T. F., Skyrme, S., Randell, R., Keenan, A., Bloor, K., Yang, H., Andre, D., Ledward, A., King, H., &
Thompson, C. (2021). Effects of computerized clinical decision support systems (CDSS) on nursing and
allied health professional performance and patient outcomes: A systematic review of experimental and
observational studies. BMJ Open, 11(12), e053886. https://doi.org/10.1136/bmjopen-2021-053886