Computer Provider Order Entry (CPOE) Quality Improvement

Table of Contents

Focus and Problem
Improvement Project
Usability
Plan
Do
Study
Act
Potential obstacles
Future Use of Knowledge
References

Focus and Problem

CPOE helped eliminate paper-based orders that were cumbersome, could get lost, and had illegible handwriting. Furthermore, it greatly improved safety due to built-in systems of enhanced patient safety in medication interaction checks as well as point-of-care clinical decision support. There are significant concerns regarding the user interface that contains embedded traps and usability issues that can lead to adverse events along with greatly hindering workflow.

Improvement Project

The quality improvement project will focus significantly on addressing the functional issues of the current CPOE systems. This includes addressing the various interface and efficiency issues that improve usability and reduce errors. Meanwhile, numerous workflow issues and competencies can be improved upon to reflect clinical settings and effective measures. Built-in pathways should be utilized by providers to guide clinical decision-making but should be allowed to be more flexible and be updated on a timely basis reflecting evidence recommendation. Complex systems will allow other staff to help manage and transmit placed orders without placing sole responsibility on providers and physicians placing the order.

Usability

As mentioned, the quality improvement will focus on improving the design interface which is one of the major issues in CPOE systems. It is not a matter of aesthetics, but practicality and usability. There are numerous instances of inconsistencies and errors when inputting orders. This can range from drop-down menus that have very similar inputs with minor differences to inconsistencies in dosage selection and commentary as demonstrated in the images on the slide. Design functionality will help to improve the accuracy of input which will reduce errors and improve efficiency.

Plan

The planning stage helps to identify and establish tasks as to why and how the intervention will take place. It is evident that the quality improvement goals are relevant to the CPOE system functionality and can be attained. These objectives can be measured both qualitatively through user surveys and quantitatively through data. The changes will be based on improving workflow functionality and ergonomic design.

Do

This stage will focus on carrying out the plan and documenting necessary data to identify successes and issues for future stages. The actual redesign must include all stakeholders including practicing physicians, experts developing the system as well as professionals in design and ergonomics. The system is then implemented on a small-scale trial to identify potential fallbacks as well as introduce the staff to the new system to receive critical feedback.

Study

The key to the Study element is to evaluate and analyze the documented data to identify gaps and determine if the quality intervention efforts are having the intended outcomes and successes. In this case, it encompasses considering staff feedback on the new system and its practical functionality as well as comparing raw data in terms of medication or input errors. This allows to perfect the system before facility-wide implementation and ensure all necessary objectives are met.

Act

During this stage, the quality improvement intervention is adopted on a larger scale or adapted based on the evaluation of data. The PDSA cycle may need to occur again before the system is functioning competently. Data should be collected continuously and constantly evaluated to identify gaps and errors. Finally, it is important to use this experience to innovate in other aspects of the healthcare environment

Potential obstacles

The project may run into a variety of issues during and after its implementation, some of which are described here. The three major elements that may go wrong are budget/costs, poor practical application, and not meeting the standards/regulations required by the government. Each challenge involves a different range of stakeholders and will have to be solved uniquely based on the circumstances and with the best methods to address these stakeholders.

Future Use of Knowledge

The knowledge gained in this scenario can be highly valuable in creating future QI initiatives. Both the successes and errors help design frameworks for implementation, highlight critical parts such as involvement of key stakeholders, budget issues, and practicality of a theoretical design. However, the PDSA utilized, exists for this very reason, to improve the implementation of the QI initiative, and identify gaps that need to be addressed the next time around.