DNP 805 Using CPOE and CDSS
Computerized physician order entry (CPOE) is one of the most successful and critical healthcare technologies deployed today to enhance care provision. CPOE is a technology that allows medical providers to enter medication orders instead of using a handwritten paper format or system. CPOE is essential in reducing medication errors, enhancing efficiency and clinical decision-making (Jungreithmayr et al., 2021). Providers can integrate a clinical decision support system (CDSS) as a tool that incorporates installed clinical knowledge and patient information to enhance patient care, especially when dealing with the opioid epidemic (Sutton et al., 2020). The essence of this essay is to assess the ordering and prescribing of opioids using a CPOE system and design a CDSS that would be integrated into an electronic health record system (EHR). The paper also offers details of the clinical issue, the rationale behind the development of the system, and describes the implementation of CDSS.
Clinical Issue
Reports and studies show that over 100 lives are lost daily in the United States due to drug overdose (HealthIT.Gov., 2018). Bart et al. (2020) assert that the efficiency of opioids for pain management and drug-seeking effects of the opioid addicts is making providers prescribe over 200 million opioids each year. Some of the physicians do not have an idea that patients are selling or abusing these prescriptions. Studies show that close to 91% of those overdosing opioids continue to receive their supply of pills even after the incident (Sutton et al., 2020). The opioid epidemic is a critical public health issue that requires effective interventions, right from the physicians prescribing these medications because of their adverse effects on health populations and individuals, especially those abusing the drugs.
Physicians can leverage CPOE and CDSS to prevent drug overdose and medication errors. Clinical decision support systems intervene at prescribing level by giving alerts to warn providers of possible adverse drug effects. The CDSS also reduces errors. The need to integrate both CPOE and CDSS is essential in ensuring that physicians generate the right information to reduce susceptibility for individuals to abuse these medications (Farre et al., 2019). CPOE offers alerts to ordering physicians, phar
macists, and administering nurses on patient allergies, current medications, and dosing based on the right weight. However, ascertaining that the new electronic processes align with physicians’ workflow is a paradoxical task as many EHRs vendors are not willing to change or turn off the medication alerts functionalities because they fear exposure to more liability. The implication is that physicians have to navigate frequent warnings with minimal clinical significance.
Development of the Design
Multiple ideas exist on how providers and organizations can address the widespread opioid problem. One approach would be having new alerts within a facility’s EHRs triggered by chosen risks for abuse. The red flags may entail if a patient has a history of being in the outpatient department on an opioid or benzodiazepine, prescription for two drugs in the last 30 days and if they have tested positive for other substances like cocaine or marijuana in the last toxicology screening (Prgomet et al., 2017).The rationale is to package all relevant data in the EHRs and place it in physician’s access at the point of care. The physician does not have to dig through charts to generate information as they try to ensure that they attend to all patients while in a busy shift.
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The foundation of developing the CDSS would be to establish a rule in the EHR system that recognizes patients at risk using searchable, unbiased gauges that can indicate the risk for abuse, misuse, and potential diversion of the prescribed opioids. The providers must leverage existing peer-reviewed information from literature and consensus opinions (Farre et al., 2019). The providers should use the information from this rule in an iterative improvement process to change the alert timing and the bare minimum or threshold for alerts to produce an adequate level of appropriate alerts at the point of care for effective decision making.
Implementation and Adoption of the CDSS
Implementing health information technology interventions in healthcare settings forms the priority of many policy agendas. Technology improvement processes are complicated undertakings and are always far from being straightforward. Implementation needs strategic planning based on systematic organizational changes linked to such programs (Srinivasamurthy et al., 2021). Any change to the workflow of healthcare providers brings frustrations and more work to ensure that the technology works to its full ability.
The first step in implementing the system would be an effective engagement of physicians and other critical care providers. Implementing this alert will require presentation to the pharmacy and physician committees to attain buy-in from the two critical stakeholders. The second step would be the integration of the CDSS with other quality improvement initiatives in the facility to align with the organization’s overall goal to enhance patient safety and quality of care (Scott et al., 2018). Through this approach, the new alert system will not significantly alter the physician workflow and help attain the desired aim. The approach will also ensure that the benefits of the CDSS are not assumed but evaluated based on the implemented system.
It is essential to have a detailed account of existing processes and initiatives before the implementation to reduce the risk of complications and help identify a current issue that this technology is designed to address (Bart et al., 2020). The CDSS strategy must align with the unique culture and practice of the organization for successful adoption and use of the technology. To attain successful implementation, the program must conduct a thorough assessment of possible barriers, like training for end and super users of the CDSS.
Challenges and Possible Solutions
The implementation of CDSS can have valuable benefits like enhancing patient care outcomes and ensuring that they do not abuse prescribed opioids. However, implementation challenges are bound. Emphasis on vital information that is clear, concise, and prompt leads to better adoption and increased positive effects. The alert triggers should be optimized to concentrate on the population of interest, disrupting workflows and physician concentration. Further, frequent alerts can lead to “alert fatigue,” making physicians and other providers ignore them, even in critical situations (Scott et al., 2018). Therefore, it is essential to validate and thoroughly test EHRs alerts to guarantee effective implementation through engagement and support from all stakeholders from the planning stage.
Conclusion
The deployment of clinical decision support systems (CDSS) through the integration of CPOE is critical to reducing medication errors and tackling the opioid crisis. The CDSS alerts clinicians to have correct treatment decisions. Well-designed CDSS and sufficient engagement and support from stakeholders like physicians and pharmacists are essential for successful implementation and ease of adoption among providers and organizations. Through these interventions, providers and stakeholders can mitigate and prevent the ever-rising opioid epidemic and its associated adverse effects on public health and individuals.
References
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