EVERYDAY INFORMATICS

Computerized Provider Order

Entry: Advancing Technology Today, Saving Lives TomorrowVALEH GHAEMMAGHAMI, BSN, RN

Anurse in the postanesthesia care unit re-

ceives a patient from the intraoperative

RN after an eight-hour procedure in the

OR. She looks at the order sheet and sees that there

are 34 new orders; however, the handwriting is

illegible and the surgeon has left the postanesthesia

care unit. The postanesthesia care unit nurse con-

sults with the charge nurse and other team mem-

bers. After some debate, she calls the surgeon to

confirm each order because of the uncertainty over

what was written and is finally able to transcribe the

surgeon’s orders and enter them into the computer.

Situations such as this scenario often occur in

US hospitals, which puts patients at risk because

of order illegibility and duplication in thick, over-

stuffed charts. Informatics and a computerized

provider order entry (CPOE) can provide a way to

prevent this. Nurses are in a position to implement

CPOE and, in this role, can engage other care pro-

viders in the process and help ensure positive out-

comes. Computerized provider order entry is a

powerful tool and a single element of the patient

care experience that should be a high priority for

perioperative team members. This form of technol-

ogy must go hand in hand with the human element

of nursing to ensure that we are fully aware of the

care that our patients receive.

BENEFITS OF CPOE

Computerized provider order entry directly affects

many facets of a health care facility and provides

http://dx.doi.org/10.1016/j.aorn.2014.09.005

� AORN, Inc, 2014

communication among every member of the care

team, including team members who are both onsite

and offsite. Because it affects patient safety and

meets meaningful use criteria, CPOE is a growing

health care trend, and many hospital leaders nation-

wide are already using or are considering using it

in their facilities.1 Employer groups, large hospitals,

and government initiatives strongly advocate the use

of CPOE. By committing the time and resources

necessary to implement CPOE throughout a health

care facility, leaders demonstrate their dedication

and commitment to patient safety and quality care.

Computerized provider order entry can enhance

nursing and provider cooperation, and is a vital

piece of the puzzle toward providing high-quality,

safe patient care.2 Another benefit of automated

health information technology, such as CPOE, is

that it strengthens nursing documentation and

care coordination among disciplines and in-

corporates evidence-based patient care practices.3

Computerized provider order entry systems have

been shown to improve patient care and the patient

experience. Also, Strohecker4 showed that CPOE

is directly linked to a reduction in medication

errors and adverse drug events.

Hospitals are increasingly turning to information

technology solutions to address issues such as

medication errors and handwriting illegibility and

to guide providers in using evidence-based prac-

tices and improve the accuracy of patient care. Use

of CPOE creates evidence-based order sets to

December 2014 Vol 100 No 6 � AORN Journal j 683

December 2014 Vol 100 No 6 EVERYDAY INFORMATICS

assist care providers in making important clinical

decisions. The benefits of electronic systems over

paper records include improved patient safety,

better times from order to action, and more-

effective application of medical knowledge.

Hospital records, procedural outcomes, and

progress notes all should be accessible, legible,

and meaningful to care providers and patients, and

CPOE provides a tangible means to that end. With

CPOE, physicians directly enter their orders into

the computer system and electronic communication

occurs with the personnel responsible for carrying

out the orders. A CPOE system improves process

turnaround times; for example, it reduces the time

from when a test is ordered to when it is actually

One of the most important challenges thatnurse leaders will face in the coming decadewill be to find a balance between the technicaland human elements of nursing.

performed. Relevant

and real-time informa-

tion becomes available

to everyone who pro-

vides care to a patient

and is the safest mech-

anism of information

sharing, much more

useful than an overstuffed and potentially confusing

paper chart. Another benefit of CPOE is a decrease in

medication errors that may result from hand-written

orders that are difficult to interpret or that contain

misplaced decimal points.5

THE NURSE’S ROLE IN IMPLEMENTINGNEW TECHNOLOGY

After a system is acquired, nurses must lead the

way in implementing adoption of the electronic

health record (EHR) and CPOE. Nurses must be

prepared to implement new technology, but they

also should be prepared for the effects that changing

technology has on them, their peers, and their pa-

tients. After an EHR is in place, for example, nurses

should strive to find the balance between technology

and the art of nursing that results in high-quality

patient- and family-centered care. One of the most

important challenges that nurse leaders will face

in the coming decade will be to find a balance be-

tween the technical and human elements of nursing

684 j AORN Journal

because nurses are responsible for ensuring that

their patients do not suffer from a lack of a human

touch as technology improves.

Nurses are at the forefront of patient care

because they are knowledgeable of clinical work-

flow and understand the needs of both patients and

providers. With nurses at the helm of EHR and

CPOE implementation, the outcome is more likely

to be positive and engaging for all care providers.

Implementing CPOE in the perioperative area is

no easy task and should be closely followed and

monitored by an implementation team. Under-

standing the workflow for all members of the team,

including nurses, surgeons, surgical technologists,

and anesthesia professionals, is vital to ensuring

a successful transition

from paper charting to

CPOE. Patient care

provided in the peri-

operative area is espe-

cially delicate and

should be documented

and archived so that

records will be secure and available to the care

providers and patient for years to come.

Computerized provider order entry and other

emerging technologies created to improve the pa-

tient experience show that the role of the periop-

erative nurse is significant.6 The science of nursing

informatics will be responsible for helping to

ensure that technology facilitates communication

among various disciplines of the health care team.

Most importantly, nurses should champion and lead

training of a technology-enabled work force, and

they must proactively create development programs

to ensure that new nurses will be prepared and

competent to use these emerging technologies.

The Institute of Medicine report, The Future of

Nursing,7 states that nurses will be called on to fill

expanding roles and to develop, implement, and

see that technological advances positively affect

patient care. Nurses must be responsible to create

sound, meaningful educational models and imple-

mentation guidelines to ensure that information

EVERYDAY INFORMATICS www.aornjournal.org

technology projects are instituted with clinical work-

flow in mind. There is no doubt that perioperative

nursing must be at the center of these projects and

lead the effort with confidence and direction.

Perioperative nurse leaders and executives

belong at the forefront of CPOE and EHR imple-

mentation and should prepare for challenges,

such as ensuring that nurses are prepared and

competent to implement emerging technologies.

Accordingly, nurse administrators and hospital

executives need to have a sound understanding of

the work involved in implementing this type of

technology. Today’s nursing leaders must remain

vigilant in recognizing how technology is chang-

ing the nursing profession and the way it is

practiced.

THE ROLE OF NURSING INFORMATICS

Perioperative nursing, as it is practiced today, is an

information-based profession. Perioperative nurses

strive to achieve success on core measures and to

follow best practices based on information that is

gathered and tested. Nursing informatics is a

developing and exciting career pathway to help

nurses combine clinical skill with information

technology and provide these benefits to patients.

Technology is the vessel that nurses use to bring

evidence-based information to patients when they

provide care; however, technology is only as good

as the people who use it.

Nurses will be responsible to train and provide

oversight to those who use new technology sys-

tems, such as CPOE. Part of their role will be to

help ensure their ongoing proficiency and skill in

using complex technological systems. All nurses

will have to demonstrate the competency to main-

tain and operate these emerging technologies with

help from nurse informatics personnel.

Planning for the future of health care is chal-

lenging, especially with all of the changes and

growth that medical facilities have on a daily basis.

However, CPOE is a patient safety initiative, and

hospitals that choose to implement the system reap

rewards, such as improved quality of care, in-

creased patient safety, and streamlined patient

care processes.2

References1. Vondrak KK. Healthcare reform, health IT, and EHRs: the

nurse executive’s role. Nurs Manag. 2012;43(12):46-51.

2. AHRQ’s Patient Safety Initiative: Building Foundations,

Reducing Risk. Agency for Healthcare Research and

Quality. http://www.ahrq.gov/research/findings/final

-reports/pscongrpt/index.html. Published 2003. Accessed

September 8, 2014.

3. Dequito AB, Mol PG, van Doormaal JE, et al. Preventable

and non-preventable adverse drug events in hospitalized

patients: a prospective chart review in the Netherlands.

Drug Saf. 2011;34(11):1089-1100.

4. Strohecker S. Polished automation tools allow patient

safety to shine. Nurs Manag. 2003;34(12):34-38.

5. Luchenski S, Balasanthiran A, Marston C, et al. Survey

of patient and public perceptions of electronic health

records for healthcare, policy and research: study pro-

tocol. BMC Med Inform Decis Mak. 2012;12(1):40-45.

6. Minesh P, Patel I, Chang J, et al. Computerized physi-

cian order entry (CPOE) Systems: an introduction.

J Pharm Res. 2012;5(10):4962-4967.

7. Committee on the Robert Wood Johnson Foundation

Initiative on the Future of Nursing, at the Institute of

Medicine and Institute of Medicine. The Future of

Nursing: Leading Change, Advancing Health. Washing-

ton, DC: The National Academies Press; 2010. http://

www.iom.edu/Reports/2010/The-future-of-nursing

-leading-change-advancing-health.aspx. Published

October 5, 2010. Accessed July 14, 2014.

Valeh Ghaemmaghami, BSN, RN, is the

director of advanced clinicals for the CPOE

project at Bayshore Medical Center, Pasadena,

TX. Ms Ghaemmaghami has no declared affili-

ation that could be perceived as posing a po-

tential conflict of interest in the publication

of this article.

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