Difference between revisions of "Nursing medication administration and workflow using computerized physician order entry"

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== Results ==
 
== Results ==
  
The results of this study revealed that VCM [[Mapping|mapping]] of semantic icons greatly increased the efficiency of data retrieval. Focus group recommendations were applied to the iconography. However, even though this system offered an improvement, the time it took to recover the information is still considerable, and needs to be improved to increased efficiency optimality in the medical field. It takes an average of 4-6 hours to learn the language but not all of the evaluators had the time to completely learn the language which might explain why it took more time to retrieve the information.<ref name="Griffon et al (2014)"> </ref> The article offers a concise background for the issue to give context for the need for improvement. As technology grows vaster, creative solutions must be created to increase interactivity. The use of ergonomic designs reveals that the ‘human’ elements are not being forgotten in design, and an eye for enjoyment of usability is being applied. This is encouraging, and the only aspect of the article that brings tangible emotionality to this discussion.
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The authors discovered that CPOE system had a negative effect on the nursing workflow because the system required the nurses to continuously click and scroll through individual patient orders.  This caused the nurses to dedicate time to “rechecking medication orders in CPOE prior to administration and charting the medications." <ref name="Tschannen"> </ref> Another discovery made by the authors included a lack of an alarm system for the nurses to know when new orders have been written by the physicians on the CPOE system.  The CPOE system did not have required time intervals that required the nurses to review patient’s medication orders.  Because of this lack of requirement, medication orders that were written as STAT were not carried out in the specified time.  Finally, the authors discovered that CPOE system reduced “formal communication between the nursing staff and physicians.<ref name="Tschannen"> </ref> Nurses were using more indirect modes of communication such as text pages to communicate with physicians.  The poor communication between the interdisciplinary team resulted in wasted time. The authors propose CPOE systems must improve on redundancy and duplicity.  Protocol orders should be designated on the CPOE system that is applicable to all patients. The authors also suggest that CPOE systems have a standardized formatting display so that orders are easier to read. This would remind nurses to check their medication orders more frequently.
  
 
== Comments ==
 
== Comments ==
  
The authors did a quality job of describing the step-by-step approach of the study. For example, the preliminary step, VCM was mapped to the iconography use in DC to allow its efficient integration with the interface. How the focus groups’ insights were applied makes it clear that technology expands through the creative input and will of people. For those with the desire to know the ins and outs of the software, a full description of CISMeF-BP was given: “This catalog gathers thousands of resources described by Dublin Core meta-data and manually indexed using Medical Subject Headings (MeSH)”. The authors cited other works that expand on the premises of their data, acknowledging the academic community that supports their work. A graphic figure including the semantic icons was presented, giving clarity to the abstract concepts.
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This article serves as a good guidance to developing CPOE that helps the nursing team carry out physician’s orders in an appropriate time frame. The authors used the feedback from the nurses to challenge future CPOE to be more efficient to alerting nurses to new orders. Being able to carry out orders efficiently will help the interdisciplinary team provide a higher quality of care to their patients.
 
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The visualization of concepts in medicine is an old tool used in a new context. The use of signs and symbols has been going on for a long time and those in the medical profession chose these symbols. The use of internal organs as signifier requires extensive knowledge of the subject matter, and to the uninitiated it appears very funny. The figure used to illustrate mapping was a good tool for explaining how these symbols correspond to complex concepts. The authors explained how the focus groups came to their signifiers.
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In conclusion, the article “Design and usability study of an iconic user interface to ease information retrieval of medical guidelines” is a good preparation for the challenges of information technology intermixing with the demands of the medical industry.  
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== References ==
 
== References ==
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[[Category: Reviews]]
 
[[Category: Reviews]]
[[Category: Interface, Usability and Accessibility]]
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[[Category: nurse, Computerized Physician Order Entry]]

Revision as of 04:01, 10 February 2015

The following is a review of the article, “Nursing medication administration and workflow using computerized physician order entry" [1] and how it addresses the impact of computerized physician order entry (CPOE) in the nurse's work.


Abstract

Computerized physician order entry (CPOE) systems are becoming widely used in many health care settings. The authors wanted to understand the impact of CPOE on nursing workflow.

Methods

The authors gathered their data by observing a total of 86 nurses. 50 nurses were observed on the pediatric unit and 36 nurses were observed on medical intensive care unit (MICU). The authors also conducted interviews with the nurses on four primary categories that included “system issues, variations in standards of care, workflow variability, and changes in communication practices.” [1]

Results

The authors discovered that CPOE system had a negative effect on the nursing workflow because the system required the nurses to continuously click and scroll through individual patient orders. This caused the nurses to dedicate time to “rechecking medication orders in CPOE prior to administration and charting the medications." [1] Another discovery made by the authors included a lack of an alarm system for the nurses to know when new orders have been written by the physicians on the CPOE system. The CPOE system did not have required time intervals that required the nurses to review patient’s medication orders. Because of this lack of requirement, medication orders that were written as STAT were not carried out in the specified time. Finally, the authors discovered that CPOE system reduced “formal communication between the nursing staff and physicians.” [1] Nurses were using more indirect modes of communication such as text pages to communicate with physicians. The poor communication between the interdisciplinary team resulted in wasted time. The authors propose CPOE systems must improve on redundancy and duplicity. Protocol orders should be designated on the CPOE system that is applicable to all patients. The authors also suggest that CPOE systems have a standardized formatting display so that orders are easier to read. This would remind nurses to check their medication orders more frequently.

Comments

This article serves as a good guidance to developing CPOE that helps the nursing team carry out physician’s orders in an appropriate time frame. The authors used the feedback from the nurses to challenge future CPOE to be more efficient to alerting nurses to new orders. Being able to carry out orders efficiently will help the interdisciplinary team provide a higher quality of care to their patients.

References

  1. 1.0 1.1 1.2 1.3 Tschannen, D., Talsma, A., Reinemeyer, N., Belt, C., & Schoville, R. (2011). Nursing medication administration and workflow using computerized physician order entry. Computers, Informatics, Nursing, 29(7), 401-410