Proposal: CPOE Implementation for Improved Patient Outcomes in ICU

This project proposal outlines the implementation of a Computerized Provider Order Entry (CPOE) system within a healthcare organization, specifically targeting the Intensive Care Unit (ICU). The proposal details the project's aim to improve patient outcomes and care efficiency by reducing medication errors and streamlining the order process. It describes the CPOE system's functionality, including electronic order transcription, safety alarms, and clinical decision support. The proposal identifies key stakeholders, including financial, medical, and IT personnel, and explains their roles. The expected benefits include decreased medication errors, improved care efficiency, and reduced patient stay. The technologies required, the project team structure, and a timeline for implementation are also provided. Potential limitations, such as increased workload during initial stages and resistance to change, are also discussed. References to relevant research support the proposal's claims and provide a comprehensive overview of the project's scope and potential impact.

Running head: PROPOSAL
Nursing informatics project
Name of the Student
Name of the University
Author Note

1PROPOSAL
Introduction
Nursing informatics encompasses the specialty discipline of nursing that combines
communications, nursing and information science, with the aim of managing and conveying
patient data. According to research evidences, informatics is imperative for addressing health
promotion, disease prevention, patient-centered care and self-care (McCormick & Saba,
2015). Often it has been found that communicating orders from a physician, concerning the
care prescribed to a patient is concomitant with transcription errors, duplicate entry of patient
orders, more time for dissemination and completion of orders, and medication errors (Smith
et al., 2018). This proposal will elaborate on a computerized provider order entry (CPOE) for
improving care delivery and patient outcomes.
Description
According to Abraham et al. (2018) CPOE systems are generally designed with the
aim of replacing the paper-based ordering system of a hospital. They allow nursing staff to
electronically transcribe the complete range of medication orders, upkeep an online
medication record, and evaluate the variations made to the orders. CPOE also generate safety
alarms that are elicited when a hazardous or duplicate order has been entered, besides guiding
caregivers in clinical decision support and highlighting the less costly substitutes that better
fit recognized hospital procedures. The initial step will encompass selecting a CPOE
specialist, particularly a nursing informaticist who will be responsible for leading the project.
Following the recruitment, efforts will be taken to work on the procedure of determining the
shift of pre-existing paper orders and addition of new orders to the tool. The specialist will
also be assigned with the task of training all nursing personnel working in the ICU through
mandatory practice sessions and computer tutorial. The goal of implementing CPOE is not to

2PROPOSAL
increase physician and nursing workload, but to eliminate chances of errors that threaten
patient safety (Moghaddasi, Sajadi & Amanzadeh, 2016).
The CPOE system will be designed such that it saves time of the nursing staff and
improves their efficiency of following physician orders. This will be realized by
incorporating a translator that will enable nurses to transcribe the order in the language that
they are familiar with, while still adhering to the medical nomenclature. The CPOE will be
linked to the electronic medical record of the hospital such that names of all patients are
available. The physician orders will be entered predominantly by selecting from a range of
order headings and subheadings. In order to place orders for particular drugs, the patient
name will be selected from the specific menu, following which the drug will be selected from
the subheadings (Jáuregui et al., 2017). Its confirmation will open up a range of subheadings
requiring particular fields like route of administration, unit, frequency, and duration,
following which the orders will be managed for decision support and analysis. Any new
medication would necessitate activation by nurse prior to sending it to the pharmacist for
processing. The specialist will also make changes in the software to save recurrent orders.
Stakeholders
At the time of planning a nursing informatics project, it is imperative for leaders to
identify the departments and personnel who will be most affected, thus ensuring their
representation amid the core stakeholder groups. Owing to the financial impact of the project
on the healthcare organization; the board members, chief financial officer and chief executive
officer will be the financial stakeholders. Other stakeholders would comprise of the chief
medical officer, ICU supervisor, project manager, IT project leaders, physicians, nurses,
technicians, and pharmacy editor. Additionally, the patients will be the end users.

3PROPOSAL
Expected patient outcomes
Implementation of CPOE has a range of benefits for patient health and safety. CPOE
is expected to facilitate the organization by decreasing the rates of medication errors by
guaranteeing that the healthcare providers, particularly nurses are able to deliver treatment
based on legible, standardized and complete medical orders (Connelly & Korvek, 2018).
Additionally, the CPOE tool will also comprise of in-built clinical decision support system
that will help in automatic checking for medication allergies, drug interaction and other
contraindications (Schiff et al., 2015). By permitting the nurses to submit orders in an
electronic format, CPOE will facilitate the organization to obtain radiology, medication, and
laboratory orders to radiology centers, pharmacies and laboratories at a faster rate, thus
improving care efficiency and reducing patient stay (Schreiber & Shaha, 2016). Some
medication orders might often require pre-approval from insurance companies. Therefore,
when incorporated with the electronic health records, the CPOE will be able to flag
medication orders required pre-approval, thus decreasing the instances of denied insurance.
Patient outcomes will also be enhanced since CPOE will improve ability of providers to entry
orders at off-site or point-of-care and will also help in error checking of incorrect or duplicate
orders (Quist et al., 2017).
Technologies
The CPOE software will have to be purchased for this project. This can be accredited
to the fact that the software will allow communication of entered medical orders over an
internet network to the different departments, nurses, and pharmacists, accountable for
completing the orders.

4PROPOSAL
Roles
The financial stakeholders will play the role of organizational leaders and assist the
project managers comprehend the fiscal effects of the project within the setting of the greater
budget. An accomplished project manager will be capable to structure things in ways that
successfully validate worth of a project to the administration’s objectives. IT project leaders
will address all concerns and clarifications about the potential advantage and drawback (if
any) of the project and obtain necessary feedback. Nurses, physicians, and technicians will
interact with one another and use the CPOE technology on an everyday basis (Olson et al.,
2015). The nursing informaticist will adorn the role of a clinical champion and act as an
advocate for the project, since he will be well-versed in the tool. Patients are the ultimate
consumers of the services and their involvement and experience will be obtained to determine
impacts of CPOE.
Timeline
The project will be implemented over a period of eight months.
Limitations
Some potential limitations of the project are that it would increase work for the nurses
during the initial stages of entering paper based orders in the software. This might result in
unfavorable workflow problems and lead to never-ending system demands. Senior nurses,
physicians, and hospital administrators might also have negative outlook towards adoption of
the new technology (Lines et al., 2015). Delegation of roles to the members of the project
might also bring about unexpected changes in power structure and professional roles.

5PROPOSAL
References
Abraham, J., Kannampallil, T. G., Jarman, A., Sharma, S., Rash, C., Schiff, G., & Galanter,
W. (2018). Reasons for computerised provider order entry (CPOE)-based inpatient
medication ordering errors: an observational study of voided orders. BMJ Qual
Saf, 27(4), 299-307.
Connelly, T. P., & Korvek, S. J. (2018). Computer Provider Order Entry (CPOE).
In StatPearls [Internet]. StatPearls Publishing.
Jáuregui, O. I., Bruchanski, L., Lede, D. A. R., Otero, C. M., & Luna, D. R. (2017).
Improving Patient Safety Through the Design and Development of a Computerized
Provider Order Entry for Parenteral Nutrition Linked to a Barcode Medication
Administration Record. In MedInfo (pp. 1038-1042).
Lines, B. C., Sullivan, K. T., Smithwick, J. B., & Mischung, J. (2015). Overcoming
resistance to change in engineering and construction: Change management factors for
owner organizations. International Journal of Project Management, 33(5), 1170-
1179.
McCormick, K., & Saba, V. (2015). Essentials of nursing informatics. McGraw-Hill
Education.
Moghaddasi, H., Sajadi, S., & Amanzadeh, M. (2016). The effect of a well-designed
computerized physician order entry on medication error reduction. Journal of Health
Management & Informatics, 3(4), 127-131.
Olson, J., Hollenbeak, C., Donaldson, K., Abendroth, T., & Castellani, W. (2015). Default
settings of computerized physician order entry system order sets drive ordering
habits. Journal of pathology informatics, 6.

6PROPOSAL
Quist, A. J., Hickman, T. T. T., Amato, M. G., Volk, L. A., Salazar, A., Robertson, A., ... &
Schiff, G. D. (2017). Analysis of variations in the display of drug names in
computerized prescriber-order-entry systems. American Journal of Health-System
Pharmacy, 74(7), 499-509.
Schiff, G. D., Amato, M. G., Eguale, T., Boehne, J. J., Wright, A., Koppel, R., ... & Bates, D.
W. (2015). Computerised physician order entry-related medication errors: analysis of
reported errors and vulnerability testing of current systems. BMJ Qual Saf, 24(4),
264-271.
Schreiber, R., & Shaha, S. H. (2016). Computerised provider order entry adoption rates
favourably impact length of stay. Journal of innovation in health informatics, 23(1),
459-465.
Smith, B., Sreeramakavacham, S., Kim, J. H., & Despins, L. (2018, July). Improving
Computerized Charting in an Intensive Care Unit. In International Conference on
Digital Human Modeling and Applications in Health, Safety, Ergonomics and Risk
Management (pp. 537-546). Springer, Cham.