|Patient safety improves with new program
by George Spain
A new clinical information system project will help close the loop in protecting patients from medication errors.
The Cardiology Service and 3W Ashley River Tower (ART) nursing unit
recently launched a computerized program called Computerized
Physician’s Order Entry (CPOE). The program, acting in concert with
other modules in the extensive patient-focused eCareNet project, will
check patient medications from initial orders to delivery.
“This is what we’ve been working toward for years, a patient-focused,
computerized checks and balances system to reduce adverse drug events,”
said Frank Clark, Ph.D., chief information officer and vice president
for information technology.
“CPOE closes the loop that begins with a physician’s orders, moves
through to pharmacy assembly on to floor delivery, then finally to a
health care worker administering the medicine,” said Melissa Forinash,
director of support services in the Office of the CIO (OCIO), and one
of the projects leaders. “A number of information services (IS)
personnel have been involved in rolling out various eCareNet modules,
including Clinical Documentation, AdminRx, and now CPOE.”
With CPOE, a physician enters initial orders into the computer, which
are then sent to a Central Data Repository (CDR) and on to the
departments, which will fulfill the orders or request for service.
Orders to connected departments, such as radiology, pharmacy, and
laboratory services, flow immediately to those systems. Non-automated
departments receive printed requisitions.
For example, a physician may order medications, lab work or X-rays
which are then sent electronically to the appropriate provider.
Many parts of the eCareNet system have been around for years. CPOE also
closes the loop by adding a physician’s direct orders in a
concise manner. This helps overcome some of the biggest causes of
medication errors due to inaccurate translation of handwriting or
confusion in verbal orders.
Orders entered in CPOE go to the pharmacy’s eMeds system (completed in
2006). The pharmacy then fills and barcodes the order (by law each is
visually checked by pharmacist) and sends the medication to the
patient’s floor. A health care provider then checks the medication’s
barcode against the patient’s wristband barcode where another part of
the eCareNet system called AdminRX (completed in October 2007) checks
meds against the initial order and the nurse is able to document the
medication as administered. The information is then forwarded to the
Using eCareNet Viewer, the entire process can be accessed by the
physician or other health care workers to check on the progress of the
Currently, CPOE is fully established in 3W ART unit. Plans call for the
system to be rolled out to the remaining non-critical care units in ART
by the end of this fiscal year. CPOE helps reduce medication errors by
ensuring that the five rights of patients are met: right patient, right
medication, right time, right dose, and right route.
Getting it wrong is costly in terms of human suffering and a hospital’s
bottom line. Studies have concluded that medication errors occur
frequently and represent a significant portion of increased
hospital costs. The authors estimate hospital costs increased by $2
billion nationally due to preventable adverse drug events for
inpatients. As a result of increased attention to medical errors, many
institutions are contemplating increased use of information technology
and clinical decision support, according to the American Medical
Informatics Association in 2002.
CPOE is MUSC’s approach to solving this problem.
Medication orders are processed and new medications are delivered to
the patient faster. CPOE results in savings by reducing paper and ink
consumption, which also contributes to a reduced environmental impact.
Along with a good plan, it takes good people to rollout a major information system like CPOE.
The IS teams included Lucy Arnold, Amy Charles, Vicki Dibble, Jim
Early, Melissa Forinash, Angela Locke, and David Strange. Chris
Alexander and Krista Moloney helped develop computer-based training
programs and classroom sessions.
In addition, Jennie Holt from pharmacy and Timothy Hartzog, M.D., from
the Department of Pediatrics worked on the project nearly full time.
Nurse managers Jennifer Minick, R.N., and Melissa Meara, R.N., for 3W
were important contributors to the workflow discussions and planning as
were members of Bonnie Foulois’s nursing informatics team. Eric Powers,
M.D., physician service line leader for heart and vascular services,
was a supportive advisor to the project.
A small physician advisory group consisting of John Waller, Larry
Afrin, Hartzog, Jim Madory, and Ken Spicer provided design and workflow
input and helped make recommendations to the overall CPOE steering
committee, chaired by Pat Cawley.
A project the size of CPOE requires a planning, management, and
cooperation between the clinical workers who will use the system,
and the information services staff and field engineers who assemble the
necessary computer technology.
Mark Daniels, the Information Services Patient Care Systems manager and
one of the leaders in the project, attributes the initial success of
the rollout to a change in the way IS approaches computerized clinical
“It used to be that a department would come to us with a plan or with
some hardware and we [IS] would begin programming to meet the original
specifications. Things would never seem to work out right, because
specs would always change,” Daniels said. “We really didn’t know what
they wanted when we started, we only knew what they asked for.
“From the beginning, CPOE was different. IS and clinicians formed
parallel teams to analyze the needs, draft the reports, and monitor
progress milestones,” Daniels added. “There would be no finger pointing
if the project got stuck, we were all in it at every step of the way.”
Daniels attributes part of the on-track success to formalized project management (PM).
PM is a structured method of approaching large undertaking by
formalizing the approach to resources, time, money, and scope in a way
that each member of the teams knows where the team is at any point.
Dan Furlong is the PM officer for OCIO and the main instructor in
MUSC’s Project Management 101 course. Furlong was an important advisor
to the CPOE project, overseeing progress and helping out team managers,
“I served alongside the eCareNet program manager with enough distance
from the project that I could provide a different vantage point
regarding issues and risks. But the real work was being done by our
project teams,” said Furlong. “CPOE’s success is a testament to what
properly focused teams can accomplish.
“Our office serves as a consultant to help MUSC project teams prepare
plans, review project performance, and facilitate meetings. We also
provided training to the team members, sometimes formally, and
sometimes on the job.” said Furlong.
In the PM 101 course, Furlong, a state certified PM, combines
multimedia presentations with hands-on exercises and group activities.
The course includes PM terms: framework, fundamentals, project life
cycle, roles, responsibilities, expectations of stakeholders and team
members, risk assessment, and software development lifecycle.
CPOE Nursing Informatics Department
by Faye Wimberly
Nursing Informatic's Team works 24/7 to prepare and teach classes for
all new Information System program implementations, including
Computerized Physician’s Order Entry (CPOE). Team members are always on
call to help users work through any problems with the new system.
RN Application Trainers include, Beth Ansel, Wanda Brown, Sharon
Harris, Janice Hazy, and Andy Roche. The trainers recently wrapped up
shooting an educational film on proper patient armband and medication
scanning techniques and clean up procedures.
RN Applications Support is provided by, Dan Gracie, Nancy Hilburn, Jo Evans, Shawn Lanham, and Terri Roberson.
Nov. 14, 2008