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Featured Project: Jones Memorial Hospital Computerized Provider Order Entry System

Submitted by Jones Memorial Hospital, Wellsville, New York

Photo of nurse using computerized provider order entry system

Computerized provider order entry (CPOE) is an electronic system in which clinicians directly enter medication orders, diagnostic tests, and procedures into a computer system, which then transmits the order directly to the pharmacy, radiology, laboratory, etc. CPOE implementation is a key strategy for reducing medication errors and preventing harm to patients. A CPOE system, at a minimum, ensures standardized, legible, and complete orders and thus has the potential to greatly reduce errors at the ordering and transcribing stages.

Several steps must take place before a hospitalized patient receives a medication ordered by a clinician:
  • Ordering: the clinician must select the appropriate medication, dose and frequency at which it is to be administered;
  • Transcribing: A clerk must read the order correctly and communicate it accurately to the pharmacist and nurse;
  • Dispensing: the pharmacist must check for drug–drug interactions and allergies, then release the appropriate quantity of the medication in the correct form; and
  • Administration: the nurse must receive the medication and supply it to the correct patient.

Studies in the patient safety literature have found that approximately 90 percent of medication errors occur at either the ordering or the transcribing stage. These errors can be due to a variety of causes, including poor handwriting and ambiguous abbreviations.

Jones Memorial Hospital, in Wellsville, New York, established a multi-disciplinary steering team charged with the planning, coordination, implementation, and evaluation of CPOE technology at the hospital. The team includes key representation from our medical staff, senior management, nursing, pharmacy quality and risk management, and information technology. The ultimate goal is to have every provider entering orders electronically, which mitigates the need for transcription and ensures that orders are legible and completely free of ambiguous and potentially dangerous abbreviations.

The focus of this project is centered on providing the highest possible level of patient safety with respect to our medication management system. Achievements have included the purchase of this new technology, the development of a comprehensive project implementation plan with clearly identified milestones, the purchase of additional hardware to support the success of the project, and standardization of patient care through the use of evidence-based order sets.

With any new implementation of technology, there are always challenges. For us, the challenges mostly centered around managing the smooth roll out of this project and assisting our clinicians (nurses and providers) in managing other clinical quality and patient safety initiatives that were being deployed simultaneously.

We are incredibly grateful for the ARC grant funding. Without it, we would not have the capital to invest in our electronic patient-safety infrastructure.