LITERATURE REVIEW: THE USE OF CLINICAL SYSTEMS TO IMPROVE OUTCOMES AND EFFICIENCIES NURS 6051

LITERATURE REVIEW: THE USE OF CLINICAL SYSTEMS TO IMPROVE OUTCOMES AND EFFICIENCIES NURS 6051

LITERATURE REVIEW: THE USE OF CLINICAL SYSTEMS TO IMPROVE OUTCOMES AND EFFICIENCIES NURS 6051

Annotated Bibliography

Lewing, B. D., Hatfield, M. D., & Sansgiry, S. S. (2018). Impact of computerized provider order entry systems on hospital staff pharmacist workflow productivity: a three site comparative analysis based on level of CPOE implementation. Journal of Hospital Administration7(1)..

The above study aimed at investigating the effect of computerized provider entry systems on the workflow productivity of staff pharmacists working in three hospitals in Houston, Texas. The research design used was an observational, prospective time as well as motion study. The sample consisted of pharmacists in three hospitals who were observed for one hour three block undertaking 38 different activities. The work categories the pharmacists were observed while undertaking them included distribution, clinical, miscellaneous, and administrative activities. The data obtained from the three hospitals was compared using descriptive as well as comparative analyses using ANOVA and Post-hoc Turkey’s range test.

The outcomes that were investigated in the study included workflow and productivity of the pharmacists while undertaking different tasks. The study also investigated the use of CPOE on time allotment and the comparison of the observed differences in time spent in the implementation of the CPOE system. The results of the study revealed that the use of CPOE the time that the pharmacists spent in implementing short and long-term CPOE activities was shorter when compared to that they utilized in implementing non-CPOE activities. It was therefore concluded that the use of CPOE can improve the work flow and productivity of the pharmacists in clinical settings. It also reduces the time that they spent in engaging in different activities in their settings.

This article has shown the effectiveness of CPOE in reducing the time that healthcare providers spent in engaging in their professional activities in the clinical settings. It has revealed that effective implementation of the CPOE systems can result in easy allocation of tasks and tracking of workflow in an institution of healthcare. Therefore, institutions that aim at improving productivity and efficiency in their operations should adopt the use of the CPOE system. Improved productivity and workflow translates into other outcomes such as enhanced quality, safety, and cost-effectiveness of care.

Okumura, L. M., Veroneze, I., Bugardt, C. I., & Fragoso, M. F. (2016). Effects of a computerized provider order entry and a clinical decision support system to improve cefazolin use in surgical prophylaxis: a cost saving analysis. Pharmacy Practice (Granada)14(3), 0-0.

The above study investigated the effects of using computerized provider order entry as well as clinical decision support system to enhance cost saving in the use of cefazolin in surgical units in Brazil. The study was before and after study design. The data on the prophylactic use of cefazolin was compared before and after the implementation of the CPOE and CDSS implementation. The authors believed that the comparative data would enable the accurate determination of the effectiveness of use of these systems. Data analysis was performed on 12-year data on cefazolin use. The 12-year data comprised of the first three years before CPOE and CDSS implementation while the remaining nine years was after the implementation of these systems. The obtained data was analyzed using Spearman rho on-parametric test to determine the use of cefazolin over the period of data collection.

The outcomes that were under investigation in the research included cefazolin use, product cost, and crude cost. The cefazolin use was defined by daily doses/100 bed-days. Product and crude costs were also defined by cefazolin use per 100 bed-days. The authors hypothesized that the implementation of the CPOE and CDSS systems will result in a net reduction in cefazolin prophylaxis use and overall costs incurred in health organizations. The outcomes of the research showed that the implementation of the CPOE and CDSS resulted in a reduction in cefazolin prophylaxis use from 6.31 DDD/100 bed-days in 2002 to 2.15 DDD/100 bed-days in 2014. The analysis also revealed that a lack of implementation of CPOE and CDSS in 2002 would have increased the costs incurred in the prophylactic use of cefazolin from $ 44, 722.99 to $116998.07.

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The results from this study reveals that effective implementation of CPOE system has significant organizational benefits. It reduces resource wastage by increasing the utilization of evidence-based decisions in the provision of care. The system also promotes cost-efficiency in the organization. It is also evident from the research that optimum outcomes with CPOE system use can be achieved when combined with other systems such as CDSS. Therefore, health organizations should implement CPOE systems as a way of reducing wastage and cutting their operational costs.

Bucher, B. T., Ferraro, J. P., Finlayson, S. R., Chapman, W. W., & Gundlapalli, A. V. (2019). Use of computerized provider order entry events for postoperative complication surveillance. JAMA surgery154(4), 311-318.

The above study was conducted with the aim of determining the effectiveness of CPOE entry events in identifying post-operative complications. The researchers focused on determining the rates of post-operative complications that were identified with the use of CPOE when compared to the use of manual medical review. Cohort study design was used to achieve the objectives of the study. The researchers reviewed 21775 medical records for patients who had undergone surgical procedures at the University of Utah from 2007 to 2017. The data on the sensitivity of the CPOE system in the detection of the complications was analyzed using the logistic regression model. The CPOE-based surveillance system was used to validate the developed models for the identified post-operative complications.

The main outcome of the study was post-operative occurrences of complications. The complications included deep surgical site infection, superficial surgical site infection, organ space surgical site infection, pneumonia, sepsis, urinary tract infection, deep vein thrombosis, septic shock, and pulmonary embolism. The analysis of the obtained data revealed that the sensitivity of the CPOE events in detecting patients who experienced one or more complications was 74.8%, specificity of 86.8%, negative predictive value of 97.55%, and positive predictive value of 33.8%. The use of CPOE events also diminished the burden of manual review of records by 55.4% to 90.3%.

The above study revealed that CPOE could be used to detect and prevent adverse events in the clinical settings. This ability can be seen in its enhanced efficiency in detecting patients who developed post-operative complications. The study also demonstrated that the use of CPOE reduces the workload for healthcare providers. This can be seen in its ability to diminish manual review of medical records. Therefore, CPOE can be used to promote patient safety and reduce workload in healthcare settings.

Lyons, A. M., Sward, K. A., Deshmukh, V. G., Pett, M. A., Donaldson, G. W., & Turnbull, J. (2017). Impact of computerized provider order entry (CPOE) on length of stay and mortality. Journal of the American Medical Informatics Association24(2), 303-309..

The above study investigated the effect of CPOE on patient outcomes that included the mortality rate and length of hospital stay. The research was conducted in an academic medical center. The study design that was utilized was a retrospective pre-post study design where data from 66185 patients and 104153 admissions seen over five-year period were analyzed. Regression analysis was used for data analysis. Generalized linear mixed statistical tests were used to control confounders in the research.

The outcomes for this research were three. They included patient outcome variables, mortality, and length of hospital stay after the implementation of the CPOE. The analysis of the obtained data revealed that the implementation of the CPOE decreased the length of hospital stay by 0.90 days. There was also a decline of mortality rate from one in every 1000 admission pre-intervention to three in every 1000 admissions post-study. However, there was a rise in mortality rates in the intensive care units. The researchers therefore concluded that CPOE system can have a predictive value in reducing length of hospital stay and mortality rates in non-acute care settings.

The study has shown that the use of CPOE system improves patient outcomes of care. These outcomes include a reduction in their overall length of stay in hospitals and mortality rates. These improvements have additional benefits such as cost-efficiency and effective use of resources in healthcare. Therefore, organizations that intend to achieve enhanced patient outcomes with their care should consider adopting the use of CPOE system.

Moghaddasi, H., Sajadi, S., & Amanzadeh, M. (2016). The effect of a well-designed computerized physician order entry on medication error reduction. Journal of Health Management & Informatics3(4), 127-131.

The above study was conducted to investigate the effect of CPOE on reducing medication errors. The study was informed by the increased cases of medication errors with the use of paper-based prescription orders. This research was a systematic review where articles for use were obtained from databases that included Google Scholar, PubMEd, EBSCO, Iranmedex, Web of Science, and Irandoc. The articles were selected based on their relevance to the objectives of the research. The researchers used 10 articles that were considered relevant for the research.

The main outcome of this research was reduction in medication errors. The reduction in the medication errors was evaluated using the number of adverse drug events reported in the articles that were used in the research. The results of the study revealed that the use of CPOE resulted in a significant decline in the incidences of serious medication errors. It also revealed its use to be associated with a great reduction in the incidences of adverse drug events. However, the researchers noted that these outcomes are largely dependent on the effective design and implementation of the CPOE system.

One of the lessons learnt from the findings of this study is that positive effect of CPOE on patient safety. This can be seen in the reduction of the incidences of medication errors in the study. It can also be seen in the reduction in the events of adverse drug reactions due to enhanced accuracy in the prescription of drugs. I have also learnt that organizations must come up with comprehensive implementation strategy for CPOE to deliver the anticipated outcomes. Therefore, health organizations should consider the use of CPOE in enhancing the safety and quality of care offered to those in need.

Conclusion

The above analysis has revealed that CPOE has positive influence on healthcare. Its effective use results in diverse health outcomes. They include reduction in workload, improvement in safety of care, and reduction in mortality rates in hospitals. The analysis has also revealed that the use of CPOE reduces the hospital stay by the patients and promotes cost-efficiency in the operations of health organizations. However, it is important that the design and implementation of CPOE be done in a careful manner for it to deliver these outcomes.

 

 

References

McGonigle, D., & In Mastrian, K. G. (2017). Nursing informatics and the foundation of knowledge. Burlington, MA : Jones & Bartlett Learning.

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