Original articleInpatient verbal orders and the impact of computerized provider order entry
Section snippets
Institutional Background
CCHMC is a 423-bed tertiary care children’s hospital with more than 760,000 patient visits each year. The hospital serves the southern Ohio, northern Kentucky, western West Virginia, and eastern Indiana region.
CPOE system
The CPOE application is part of a larger Integrating Clinical Information System (ICIS), whose core applications include a web-based portal, CPOE, clinical documentation, and a data repository (INVISION; Siemens Medical Solutions, Malvern, PA). ICIS is a proprietary system that has been
Results
Data from electronic order audits conducted from August 2003 to January 2004 (the stable CPOE period) were analyzed. During this period, a mean of 19,996 ± 521 orders were generated weekly; 2094 ± 65 (10%) of these were verbal orders. The highest rates of verbal orders were from the psychiatry (74%; 578/784), cardiac intensive care (13%; 162/1248), and surgical short-stay (6%; 33/557) units. The lowest rates of verbal orders were from pediatric intensive care (2%; 53/2777), clinical research
Patient Safety
Verbal orders have become a target for medical institutions in efforts to improve patient safety practices and prevent medication errors. Institutions use recommendations to promulgate guidelines for preventing verbal orders; however, often these recommendations are not evidence-based. One of the only studies examining the use of verbal orders and medication errors reported a decreased risk of errors with verbal orders.15 However, errors were generated by a pharmacy review or an incident report
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2017, Research in Social and Administrative PharmacyA review of verbal order policies in acute care hospitals
2012, Joint Commission Journal on Quality and Patient SafetyEvaluating the medication process in the context of CPOE use: The significance of working around the system
2011, International Journal of Medical InformaticsCitation Excerpt :However, as seen in certain circumstances, the context of CPOE use compelled the providers to bypass it. Verbal orders then were still frequently used, although it is supposed that the implementation of CPOE systems should decrease their number significantly [24,25]. The fact that these verbal orders are entered only later by the responsible physician or even his/her colleagues simply for documentation purposes (if not entirely forgotten) questions the high hope of CPOE's beneficial impact on patient safety.
The Impact of Computerized Provider Order Entry Systems on Inpatient Clinical Workflow: A Literature Review
2009, Journal of the American Medical Informatics AssociationCitation Excerpt :A similar trend was shown in a Children's Hospital.54 Three studies showed that the rate of order countersignatures improved.46,54,60 Using CPOE systems was found to be time-consuming for clinicians.
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A list of the members of the Clinical Informatics Outcomes Research Group is available at www.jpeds.com.