Don’t Forget CPOE’s Dramatic Impact on Nursing

My last post focused on CPOE and how to at least start planning for an implementation with your physicians. We all know this is the most painful transition our medical staffs have experienced in years; so working with them early and often is the key.

But physician are not the only group of clinical staff that have to go through a metamorphosis of everything they’ve ever learned during a CPOE implementation. Nurses feel a lot of pain as well. For the nurse, the daily routine is taking orders from the physicians, entering orders for the physicians, calling physicians because orders are not correct or don’t look correct, running down physicians because vitals are high or low or the patient is complaining of pain and the list goes on and on. The whole nursing process is turned upside down once your CPOE system is LIVE.

Why wouldn’t it be easier for nursing? I mean, we are taking a good chunk of the non-clinical work away from them by moving the order entry process to the physician. Well, sort of. For nurses, everything begins with the order. In the paper world, nurses know there is an order and something to be done to a patient because the physician hands them a sheet of paper with the list of things to do. A grocery list, so to speak. The nurse looks it over and gets to work fulfilling them as quickly as possible by entering orders in the system for lab, radiology, etc. The key to this is the nurse does not start at the computer. They start with a piece of paper and go to the computer.

To us techies, it doesn’t seem like a huge deal or shift in the workflow, but for nurses it is. Most nursing teams are not oriented to watch a screen or check a computer every few minutes to see what they need to do. They have a note or sticky in their pocket or they have a piece of paper giving them direction. Most nursing units don’t possess enough equipment for every nurse to have their own machine. Problems range from the fact that, for example, the equipment is there but not necessarily in the correct location, or the “status board” for nursing isn’t oriented to the workflow of the unit. We ran into every one of these issues during our process, even though we planned and planned and planned.

Another major issue to work on is how nurses will be notified when new orders are placed. Today, in the greater number of facilities, most nurses expect orders when they see the physician making rounds or when the physician drops by the unit. In the electronic world of CPOE, the physician is ordering from anywhere they can get access to put orders in. And the majority of the time, they are not on the unit when they put the orders in for a patient. In the old world, the queue for new orders is “seeing” the physician or getting a phone call from a physician.

It’s a major change in the CPOE world. Nurses need time to acclimate to that new process. As well, how are they communicating with the physician once they get new orders? What if there are issues with the orders, does the nurse correct them and let the physician know? What happens for stat orders that come across but the nurse doesn’t know they are there. Many, many issues arise and, honestly, many of them we cannot plan for during an implementation. IT just doesn’t understand enough of how it works to figure out how to make it work.

So my “recommendation of the day” is really no different than what I described for your medical staff. Put together a Nursing Informatics Committee made up of front-line nurses. Meet, meet and meet again discussing the possible changes and transitions that will occur during the CPOE process. Have the committee poll and question their peers for solutions to identified problems and work through those now! Listen and listen and listen again.

Communication, trust and collaboration with your nursing staff will go a long, long way to helping your team be successful during this process. Your nurses have the knowledge you need; they understand their process and the physician process better than we ever will. Use that to your advantage by including them in the process early and often. Good luck.