Impact of a computerized physician order entry system on nurse-physician collaboration in the medication process
International Journal of Medical Informatics , Volume 77 - Issue 11 p. 735- 744
Background: Due to their efficiency and safety potential, computerized physician order entry (CPOE) systems are gaining considerable attention in in-patient settings. However, recent studies have shown that these systems may undermine the efficiency and safety of the medication process by impeding nurse-physician collaboration. Objective: To evaluate the effects of a CPOE system on the mechanisms whereby nurses and physicians maintain their collaboration in the medication process. Setting and methodology: Six internal medicine wards at the Erasmus Medical Centre were included in this study. A questionnaire was used to record nurses' attitudes towards the effectiveness of the former paper-based system. A similar questionnaire was used to evaluate nurses' attitudes with respect to a CPOE system that replaced the paper-based system. The data were complemented and triangulated through interviews with physicians and nurses. Results: Response rates for the analyzed questions in the pre- and post-implementation questionnaires were 54.3% (76/140) and 52.14% (73/140). The CPOE system had a mixed impact on medication work: while it improved the main non-supportive features of the paper-based system, it lacked its main supportive features. The interviews revealed more detailed supportive and non-supportive features of the two systems. A comparison of supportive features of the paper-based system with non-supportive features of the CPOE system showed that synchronisation and feedback mechanisms in nurse-physician collaborations have been impaired after the CPOE system was introduced. Conclusion: This study contributes to an understanding of the affected mechanisms in nurse-physician collaboration using a CPOE system. It provides recommendations for repairing the impaired mechanisms and for redesigning the CPOE system and thus for better supporting these structures.
|CPOE, Collaboration, Communication, Evaluation, Interoperability, Medication order entry system, Medication system, Patient safety|
|International Journal of Medical Informatics|
|Organisation||Erasmus MC: University Medical Center Rotterdam|
Pirnejad, H, Niazkhani, Z, van der Sijs, I.H, Berg, M, & Bal, R.A. (2008). Impact of a computerized physician order entry system on nurse-physician collaboration in the medication process. International Journal of Medical Informatics, 77(11), 735–744. doi:10.1016/j.ijmedinf.2008.04.001