Frozen: CPOE Is Change Worth Melting For

Purpose:
The purpose of this presentation is to share methodology and innovative safety tools to be used by nursing when implementing health information technology (HIT) solutions, specifically related to computerized provider order entry (CPOE) processes, powerplan functionality, and staff engagement.

Relevance/Significance:
As described in The Joint Commission's Sentinel Event Alert #54 and the ECRI Institute's Top 10 Patient Safety Concerns in 2015, HIT is a variable that affects nurses' ability to deliver safe, high-quality care. In response to incentives or penalties related to the American Recovery and Reinvestment Act, healthcare organizations have experienced a paradigm shift in patient care delivery resulting in rapid changes that can lead to uninformed staff and unexpected adverse consequences.

Strategy and Implementation:
This organization that attained ARRA Stage 2 attestation in 2014 developed methodology for implementing CPOE safely with phases of mapping, building, testing, and education for each specialty. The multidisciplinary team was led by nursing, involved nursing in all phases, and allocated additional staffing with 100 superusers who were engaged frontline providers to support safe practice. This team developed powerplans to translate paper processes to electronic form through workflow redesign using LEAN tools. Safety measures included Test Bundles, built in core measures, alerts for powerplans in a planned state, and rules for single selection of narcotics to avoid the “narcotic buffet” for medication administration. The use of failure mode/affects analysis, safety checklists, along with governance from multidisciplinary leadership are means of error prevention and quality improvement (QI) . Lewin's change model along with transformational leadership underpins the success of these efforts.

Evaluation:
One example of QI was venous thromboembolism prophylaxis (VTEP). Medical patients received VTEP at a rate of 79.9%, while surgical patients received VTEP at a rate of 99.1%. This success is credited to the use of post-operative powerplans that contain VTEP and documentation options that align with provider workflow.

Implications for Practice:
Implications for nursing practice involve knowledge sharing and application of innovative methodologies that promote a culture of safety and a focus on QI, as well as leadership to facilitate change safely. While the unfreezing phase of change is a challenge, CPOE is change worth melting for!