| Evaluating the medication process in the context of CPOE use: The significance of working around the system. | |
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MedLine Citation:
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PMID: 21555237 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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OBJECTIVE: To evaluate the problems experienced after implementing a computerized physician order entry (CPOE) system, their possible root causes, and the responses of providers in order to incorporate the system into daily workflow. METHODS: A qualitative study in the medication-use process after implementation of a CPOE system in an academic hospital in The Netherlands. Data included 21 interviews with clinical end-users, paper-based and system-generated documents used daily in the process, and educational materials used to train users. FINDINGS: The problems in the medication-use process included cognitive overload on physicians and nurses, unmet information needs, miscommunication of orders and ideas, problematic coordination of interrelated tasks between co-working professionals, a potentially faulty administration phase, and suboptimal monitoring of the medication plans. These problems were mainly rooted in the lack of mobile computer devices, the uneasy integration of coexisting electronic and paper-based systems, suboptimal usability of the system, and certain organizational factors with regard to procuring drugs affecting the technology use. Various types of workarounds were used to address the difficulties, including phone calls, taking multiple paper notes, issuing paper-based and verbal orders, double-checking, using other patients' procured drugs or another department's drug supply, and modifying and annotating the printed orders. CONCLUSION: This study shows how providers are actively involved in working around the interruptions in workflow by bypassing the technology or adapting the work processes. Although certain workarounds help to maintain smooth workflow and/or to ensure patient safety, others may burden providers by necessitating extra time and effort and/or endangering patient safety. It is important that workarounds having a negative nature are recognized and discussed in order to find solutions to mitigate their effects. |
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Authors:
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Zahra Niazkhani; Habibollah Pirnejad; Heleen van der Sijs; Jos Aarts |
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Publication Detail:
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Type: JOURNAL ARTICLE Date: 2011-5-7 |
Journal Detail:
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Title: International journal of medical informatics Volume: - ISSN: 1872-8243 ISO Abbreviation: - Publication Date: 2011 May |
Date Detail:
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Created Date: 2011-5-10 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 9711057 Medline TA: Int J Med Inform Country: - |
Other Details:
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Languages: ENG Pagination: - Citation Subset: - |
Copyright Information:
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Copyright © 2011 Elsevier Ireland Ltd. All rights reserved. |
Affiliation:
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Institute of Health Policy and Management (iBMG), Erasmus University Rotterdam, Rotterdam, The Netherlands; Department of Medical Informatics, Urmia University of Medical Science, Urmia, Iran. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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