Nursing medication administration and workflow using computerized physician order entry
The following is a review of the article, “Nursing medication administration and workflow using computerized physician order entry"  and how it addresses the impact of computerized physician order entry (CPOE) in the nurse's work.
Computerized physician order entry (CPOE) systems are becoming widely used in many health care settings. The authors wanted to understand the impact of CPOE on nursing workflow.
Six Rights of Medication Administration
- Right Individual
- Right Medication
- Right Dose
- Right Time
- Right Route
- Right Documentation
The authors gathered their data by observing a total of 86 nurses. 50 nurses were observed on the pediatric unit and 36 nurses were observed on medical intensive care unit (MICU). The authors also conducted interviews with the nurses on four primary categories that included “system issues, variations in standards of care, workflow variability, and changes in communication practices.” 
The authors discovered that CPOE system had a negative effect on the nursing workflow because the system required the nurses to continuously click and scroll through individual patient orders. This caused the nurses to dedicate time to “rechecking medication orders in CPOE prior to administration and charting the medications."  Another discovery made by the authors included a lack of an alarm system for the nurses to know when new orders have been written by the physicians on the CPOE system. The CPOE system did not have required time intervals that required the nurses to review patient’s medication orders. Because of this lack of requirement, medication orders that were written as STAT were not carried out in the specified time. Finally, the authors discovered that CPOE system reduced “formal communication between the nursing staff and physicians.”  Nurses were using more indirect modes of communication such as text pages to communicate with physicians. The poor communication between the interdisciplinary team resulted in wasted time. The authors propose CPOE systems must improve on redundancy and duplicity. Protocol orders should be designated on the CPOE system that is applicable to all patients. The authors also suggest that CPOE systems have a standardized formatting display so that orders are easier to read. This would remind nurses to check their medication orders more frequently.
This article serves as a good guidance to developing CPOE that helps the nursing team carry out physician’s orders in an appropriate time frame. The authors used the feedback from the nurses to challenge future CPOE to be more efficient to alerting nurses to new orders. Being able to carry out orders efficiently will help the interdisciplinary team provide a higher quality of care to their patients.
- Tschannen, D., Talsma, A., Reinemeyer, N., Belt, C., & Schoville, R. (2011). Nursing medication administration and workflow using computerized physician order entry. Computers, Informatics, Nursing, 29(7), 401-410 http://www.ncbi.nlm.nih.gov/pubmed/21164338
- The Joint Commission (2010). Standards and patient safety goals. http://www.jointcommission.org/AccreditationPrograms/Hospitals. Accessed March 8, 2010.
- Federico F. The five rights of medication administration. 2007. http://www.ihi.org/IHI/Topics/PatientSafety/MedicationSystems/ImprovementStories/FiveRightsofMedicationAdministration.htm. Accessed March 8, 2010.