Int J Med Inform - Evaluating the medication process in the context of CPOE use: the significance of working around the system.

Tópicos

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Resumo

JECTIVE: To evaluate the problems experienced after implementing a computerized physician order entry (CPOE) system, their possible root causes, and the responses of providers in order to incorporate the system into daily workflow.METHODS: A qualitative study in the medication-use process after implementation of a CPOE system in an academic hospital in The Netherlands. Data included 21 interviews with clinical end-users, paper-based and system-generated documents used daily in the process, and educational materials used to train users.FINDINGS: The problems in the medication-use process included cognitive overload on physicians and nurses, unmet information needs, miscommunication of orders and ideas, problematic coordination of interrelated tasks between co-working professionals, a potentially faulty administration phase, and suboptimal monitoring of the medication plans. These problems were mainly rooted in the lack of mobile computer devices, the uneasy integration of coexisting electronic and paper-based systems, suboptimal usability of the system, and certain organizational factors with regard to procuring drugs affecting the technology use. Various types of workarounds were used to address the difficulties, including phone calls, taking multiple paper notes, issuing paper-based and verbal orders, double-checking, using other patients' procured drugs or another department's drug supply, and modifying and annotating the printed orders.CONCLUSION: This study shows how providers are actively involved in working around the interruptions in workflow by bypassing the technology or adapting the work processes. Although certain workarounds help to maintain smooth workflow and/or to ensure patient safety, others may burden providers by necessitating extra time and effort and/or endangering patient safety. It is important that workarounds having a negative nature are recognized and discussed in order to find solutions to mitigate their effects.

Resumo Limpo

jectiv evalu problem experienc implement computer physician order entri cpoe system possibl root caus respons provid order incorpor system daili workflowmethod qualit studi medicationus process implement cpoe system academ hospit netherland data includ interview clinic endus paperbas systemgener document use daili process educ materi use train usersfind problem medicationus process includ cognit overload physician nurs unmet inform need miscommun order idea problemat coordin interrel task cowork profession potenti faulti administr phase suboptim monitor medic plan problem main root lack mobil comput devic uneasi integr coexist electron paperbas system suboptim usabl system certain organiz factor regard procur drug affect technolog use various type workaround use address difficulti includ phone call take multipl paper note issu paperbas verbal order doublecheck use patient procur drug anoth depart drug suppli modifi annot print ordersconclus studi show provid activ involv work around interrupt workflow bypass technolog adapt work process although certain workaround help maintain smooth workflow andor ensur patient safeti other may burden provid necessit extra time effort andor endang patient safeti import workaround negat natur recogn discuss order find solut mitig effect

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