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Electronic system for physicians’ orders improves patient safety

by Kristina Goodnough - April 23, 2007

Handwritten orders have become a thing of the past for patients and their caregivers in the John Dempsey Hospital’s intensive care and cardiac step down units, where an electronic system for entering physicians’ orders was recently adopted.

The system, introduced on a pilot basis on one of the surgical floors last spring, is designed to improve patient safety and reduce medical errors.

“The electronic physician order entry system not only eliminates handwriting and transcription errors, it provides many online alerts and warnings for clinical caregivers, and distributes orders as they are written directly and immediately to ancillary units,” says Roberta Luby, assistant vice president for information technology strategic projects, who supervised the rollout.

“The process is much safer and more streamlined.”

When a physician orders a medication for a patient with the new electronic system, the order goes to the pharmacy with no manual intervention.

Similarly, an order for an X-ray or other diagnostic test goes directly to the radiology department or the lab.

“Generally with online orders, medications, diagnostics, and therapies can be delivered much more quickly to our patients,” says Luby, “with greatly reduced chances for confusion or error.”

The physician order entry system “went live” in the intensive care and cardiac step down units on April 3, after months of preparation and training.

And for the first two weeks, each shift was staffed with at least one nursing “super user” who could help answer questions.

“We wanted time to monitor all the processes and make sure everything was working smoothly, and provide the necessary training,” says Dr. Richard Simon, chief of staff and physician liaison to the IT Department.

“The initial rollout taught us a lot about workflow,” he says.

Rosemary Swanks, left, and Dana Vibert use the automated system for entering physicians’ orders at the Health Center.
Rosemary Swanks, left, and Dana Vibert use the automated system for entering physicians’ orders at the Health Center.
Photo by Janine Gelineau

“We also learned that customization means greater acceptance; so for the second rollout, we spent a lot of time developing order sets or lists of orders and tests around a particular procedure or disease that make it easier to select the necessary items. Once you learn the system, it’s faster than using a pen.”

But although ease of use is important, adds Simon, the primary goal is patient safety.

As physicians enter new orders in the online system, the computer screen shows alerts based on existing orders.

These may be related to possible allergies or drug interactions. Orders approaching expiration are highlighted. Priority orders appear in red.

“”It really cuts back on redundancy,” says Paula McCauley, a nurse practitioner in the intensive care unit, who is a new user.

“When you accept a new patient from another floor, all the orders and notes are already in the system. That’s especially helpful with long-term patients.”

The system takes some time to learn, says Kathleen Pellizzari, a nurse on the seventh floor who helped with the rollout in the intensive care and cardiac step down units as a superuser, “but the order information is much more concise and accurate. And it’s safer. You don’t have to decipher handwriting and try to figure out where a decimal point goes, things like that.”

Adds Simon, “The system has a vast potential to continue to improve the quality of care offered to our patients. As people learn the power of the system and the difference it can make, they don’t want to work with paper orders ever again.”

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