Transition of Hospitals and Pharmacies to CPOE

With the advancement in health care systems, the world is shifting towards better, faster and sustainable technologies. Health care systems are inclined towards a decrease in mortality rate, numerous errors have been reported by health care professionals in past due to misdiagnoses or by prescribing wrong medications. Of course, physicians/prescribers are human, and errors can be made when they must go through multiple steps for patients, including:
• Prescribe
• Transcribe
• Administer
• Monitor

CPOE is a new method of transitioning hospitals and pharmacies, with this advanced system doctors will be able to remember which patient has a drug allergy or may be exposed to harmful drug-drug or drug-food interaction. There is a fair chance of errors occurring in prescribing stage as the physician may not recall, or have to sift through a lot of paper, to what previous medication the patient has been taking, failure in reading the transcript, failure to understand handwriting, an inadequate dosage of drugs and drug allergies.

CPOE stands for Computerized provider order entry. Now, what does this term mean? Let me tell you, A Provider is a physician, physician extender, or prescriber who can write orders such as medications such as licensed anaesthetics, nurses or those who are covered under this term. It is anyone who is licensed or registered to not only write orders but also prescribe medications. CPOE implies that providers or physicians can directly enter orders into an electronic medical record rather than handwriting them on physical paper or otherwise in an independent electronic system.

So, why is CPOE important?
Handwritten orders are reasonably difficult to interpret. For example, a physician has prescribed a drug with ID which is twice a day but it could also be IO or IB. there could be a spelling mistake by the physician, he puts a question indicating he forgot the spelling and he didn’t recollect it, but there are many drugs that have similar looking spellings and other providers are unable to guess what the physician wanted to prescribe unless they study the case again.
However, in the CPOE world medications are very clearly in the database and if there is a missing order, the built-in AI system of the computer detects it as an incomplete order. It could be because it hasn’t identified the dosage of the drug being administered to the patient. This system is also able to detect mal drug interaction for instance if a patient has GI bleeding and a physician is unaware of it and has prescribed blood thinners the system will detect it as soon as it entered.

Eliminate errors in Medical practice
With this advanced system, it has been made a lot easier for doctors and as well patients. Because of CPOE doctors can access the history of the patient from anywhere, order test and directly enter new medical records from a digital device. CPOE may include the electronic transmission of that order to another department such as the pharmacy or pathology department coupled with a clinical decision support system

CPOE not only clears up the handwriting issue but makes sure that the orders are completely detailed. It leaves no error of confusion between a physician who is prescribing and transcribing drugs to a nurse who is attending that patient and a pharmacist who is responsible for the approval of drugs making sure that there is no reason medication shouldn’t be given such as an interaction or duplication of wrong dose. 3 people are looking at every medication who are responsible for reviewing and approving the drug. It is fast and accurate patient no longer has to wait long for the order to be approved.
If the order is illegible, to begin with, there are delays in every step of the process. Often delay in the medication for a few hours could be critical for the patient. If the person is suffering from an infection and is in a life-threatening situation, time is all that matters that can make the patient live or die.

Functionality and reliability of CPOE
There could be a problem of availability and you could end up giving the wrong medication, dose, frequency or route. Sometimes the provider is unable to identify the signature of the physician and is unable to contact him on time to discuss what he has prescribed. The provider doesn’t know whom to call and there is considerable delay in the administration of medication.
Five rights of medication approved with CPOE
Whereas CPOE is swift because the order is placed into an electronic system and immediately available for physician and physician extenders to review it and put the patient on the right medication immediately. It also eliminates the error if someone wants to change the medication from right to wrong administration of the dose. With CPOE the patient receives the first dose quickly and it meets the five rights of medication which are
• Right patient
• Right drug
• Right dose
• Right frequency
• Right route
So there’s no issue because the medication is put into the patient's chart and attached to the barcode scanning so that the nurse scans their badge from the patient’s armband and administers the pills and medications.

Enhance patient safety and healthcare delivery system
CPOE allows less handling by physicians and providers because it does not have to be re-entered. In addition to all of this, it allows clinical decision support. It also reduces the utilizing of inpatient laboratory by anywhere 20% to 30% just by limiting the number of ongoing standing orders around laboratories in the physician order rather than someone who’s not clinical, or patient who’s just getting routine check-ups and getting lab test which adds to the cost and patient losing blood as a result of blood samples.
What’s an order set?
Now an order set is a collection of order sentences that are arranged around common procedures, common conditions, common scenarios so for instance if I'm omitting a patient with congestive heart failure what are the orders and order sentences that typically would want to include so that I don't miss any of the important things to monitor a patient with congestive heart failure likewise I might have an order set for the routine care of a post-op total hip replacement which would include things like physical therapy getting the patient out of bed, getting a catheter removed within 24 hours of surgery and these are things that help to improve outcomes with patient care and prevent a lot of the omissions that or when a physician has to remember to do these things and it adds a lot of efficiencies because it is quicker to order an order set than it is to go through and place individual orders.

Physicians had to go looking through a file cabinet for a people order set that's pointed out they have to stamp it they have to sign it they have to put it on the patient's chart and order sets are commonly an efficiency gain for the providers because they open the electronic chart they have their favourite order sets that they use over and over again they pre-configure them and then they can order this very quickly so they don't have to go looking for them they don't have to tag them because they're already in the patient's chart and they're immediately available to everyone so this is one of the great time savers of CPOE.

How CPOE has benefitted our health care system?
CPOE is far-reaching technology as it affects everyone in the organization from administration to provider to patients. You don't have to order sets for every physician you would like to see some harmonization around common procedures and some agreement on what a typical CHF patient or a total hip replacement patient would need so that you can eliminate variability you improve the ability of the nurses doing the same thing over and over again and less likely to miss things when everyone's doing it differently.

An effective approach for patient’s treatment
So it has been shown to improve patient outcomes now reminders are notes that are typically included on order sets and they can be helpful to remind people to do things but they're really helpful to remind physicians not to do things that are no longer proven to be evidence-based so for instance we used to give children with asthma what we call chest percussion and drainage when they were in the hospital that's basically percussing they're back with the idea of mobilizing secretions and that's actually helpful in some patients with structural lung diseases like bronchiolitis or a cystic fibrosis but in a routine child with asthma it's actually been associated with an increase in hospital acquired pneumonia so that is something we might want to put on an asthma order set to remind physician that is no longer appropriate and to exclude that order for chest percussion and drainage from the order set the first place so reminders can be useful for omissions and to remind physicians of practices that are no longer appropriate reminders can also be linked to the evidence so that when you click on the reminder that shows where exactly the evidence resides and how timely it is.
In how many ways CPOE is helpful?

Drug to drug interaction
CPOE is very helpful because the computer can be monitoring all the medications the patients on and when a new prescription is written or a new medication prescribed it can look and see if there's anything already prescribed that might create a serious consequence or interaction that would be known as a drug to drug interaction.

Allergic response to drugs and certain foods

Drug allergy alerts warn the physician if they try to prescribe something that the patient has a known allergy to drug food alerts are helpful in the outpatient realm where we can remind patients that certain medications such as first-generation oral diabetic medicines shouldn't be used with alcohol because of a reaction you can get so you can write rules to write out alerts to the patient's instructions that they go home with to remind them that certain drugs may interact with certain medical foods in their diet and they need to consider avoiding those foods.

Age-adjusted dosage

The drug dose can look at things like the age of the patient and say that's a totally an appropriate dose for that two-year-old or it's not enough of the medication prescribed for an antibiotic given to someone who's 220 pounds and you should be given 2 grams without antibiotic rather than one gram of antibiotic so those are called age-adjusted dosing and weight-adjusted dosing which can occur in the form of alerts.

Benefits of CPOE
• It helps providers to automate clinical data of patients in the electronic medical record, which helps to decrease errors in medication and reduce hospital stay thus benefitting the patient and decreasing the hospital expenses.
• It helps providers and physicians to create analytics for individual patients and monitor progress to prove outcomes of the care model administered to the patients.
• It helps provider in making optimal ordering decisions by enabling a clinical decision support system.
• With cope, the provider can access and order from anywhere despite the location difference

Takeaway
CPOE has revolutionized our health care system. It has been currently used in healthcare systems as a replacement for the more traditional methods of placing a variety of order types including written papers prescriptions, verbal in person or via telephone and fax in any healthcare setting where tests and medications are ordered performed or administered.
It has its advantages and disadvantages, but it has changed the world, with advanced CPOE there is minimal chance of errors. Providers and patients can access clinical data from anywhere in the world. A physician can order and monitor prescription with just one click. Studies have shown that the mortality rate has significantly decreased over the past few years after the implementation of CPOE in hospitals. There is a considerable decrease in the death rate due to medical staff errors.

Transition of Hospitals and Pharmacies to CPOE

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