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Int J Med Inform. 2008 Nov;77(11):735-44. doi: 10.1016/j.ijmedinf.2008.04.001. Epub 2008 Jun 2.

Impact of a computerized physician order entry system on nurse-physician collaboration in the medication process.

Author information

1
Healthcare Governance, Department of Health Policy and Management, Erasmus University Medical Centre, Rotterdam, The Netherlands. h.pirnejad@erasmusmc.nl

Abstract

BACKGROUND:

Due to their efficiency and safety potential, computerized physician order entry (CPOE) systems are gaining considerable attention in in-patient settings. However, recent studies have shown that these systems may undermine the efficiency and safety of the medication process by impeding nurse-physician collaboration.

OBJECTIVE:

To evaluate the effects of a CPOE system on the mechanisms whereby nurses and physicians maintain their collaboration in the medication process. SETTING AND METHODOLOGY: Six internal medicine wards at the Erasmus Medical Centre were included in this study. A questionnaire was used to record nurses' attitudes towards the effectiveness of the former paper-based system. A similar questionnaire was used to evaluate nurses' attitudes with respect to a CPOE system that replaced the paper-based system. The data were complemented and triangulated through interviews with physicians and nurses.

RESULTS:

Response rates for the analyzed questions in the pre- and post-implementation questionnaires were 54.3% (76/140) and 52.14% (73/140). The CPOE system had a mixed impact on medication work: while it improved the main non-supportive features of the paper-based system, it lacked its main supportive features. The interviews revealed more detailed supportive and non-supportive features of the two systems. A comparison of supportive features of the paper-based system with non-supportive features of the CPOE system showed that synchronisation and feedback mechanisms in nurse-physician collaborations have been impaired after the CPOE system was introduced.

CONCLUSION:

This study contributes to an understanding of the affected mechanisms in nurse-physician collaboration using a CPOE system. It provides recommendations for repairing the impaired mechanisms and for redesigning the CPOE system and thus for better supporting these structures.

PMID:
18514020
DOI:
10.1016/j.ijmedinf.2008.04.001
[Indexed for MEDLINE]

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