Magnet Nurses Embrace Computerized Provider Order Entry (CPOE) to Increase Patient Safety Standards.

1. Magnet Nurses Embrace Computerized Provider Order Entry (CPOE) to Increase Patient Safety Standards. Kaileen Runnells BSN, RN The Acadia Hospital Bangor, Maine

2. Background • The Acadia Hospital is a free standing Psychiatric Mental Health Magnet Hospital in rural Maine that is committed to improving patient safety standards. This project will discuss our hospital’s philosophy of implementing change specific to CPOE. This project will assist other hospitals in the incorporation of CPOE.

3. WHY CPOE The case for implementing Computerized Physician Order Entry is strongly linked to an organization’s desire to improve the safety and quality of health care The primary mission of the Acadia Hospital is the provision of both hospital-based and community-based mental health and substance abuse treatment services to the people of Maine that reflects the provision quality services fostering dignity and positive environment. Patient First with Patient Safety is a key priority Why? Advances in patient safety is a requirement of Magnet Status. As a healthcare facility in the 21st century there is high rates of human error due to system failures. This process can assist the healthcare facility in reduction of human error with implementation of checks and balances Federal Stimulus Package for electronic documentation

4. Theoretical background Patricia Benner’s Novice to Expert theory was used to incorporate a strategic method of implementing computerized charting that would involve nursing at all levels of the organization The Coach Model

5. Identifying champions The coach model Integration into multidisciplinary existing hospital committees: Nursing leadership, Medical Staff Leadership, Compliance Committee, Executive and Clinical Leadership Committee Go live support Continuous improvement and evaluation Our champions: Medical director, Chief Nursing Officer 3 doctors from patient care areas identified as knowledgeable and key to implementing CPOE Doctors, LIP's were asking for electronic charting, and order entry. Keys Steps Identifying Champions

6. The Coach Model 2002 EMHS and The Acadia Hospital started electronic charting. While working as a floor nurse our nurse educator began working with education to teach and implement electronic charting to employees. In 2007/2008 Nurse educator began interviewing and questioning the process of educating nurses and doctors regarding electronic charting. The Coach model was utilized and revised. Why did we choose the coach model? Identified as the best model to disseminate information to all staff (subject matter experts) “SME”. Promoted end-user (nurses, psychiatric technicians, doctors, secretaries, and clinicians) involvement which encouraged buy in by all staff. Involved them in the decision making process

7. How did we Utilize Coaches As classroom instructors, floaters, and/or facilitators As end-user conversion support coaches at go-live As end-user support post go-live Participate in MEETINGS Interface with the Training Coordinator, Department Managers and project team to accomplish training Make referrals when special training situations occur Serve as the main provider of work area support Serve as a resource and mentor in performing proper application functions on the job Ideal ratio: One Computer Coach for every 15 end users.

8. Who is a Coach • Someone that can make a positivecontribution to • the implementation of a project. • Reliability (good attendance, punctuality) • Ability to learn quickly and facilitate learning to others • Capable of getting along with others • Leadership traits • High quality of work • Positive attitude • Positive peer interaction and interpersonal skills • Basic computer skills • Develop expertise in the use of Cerner/other applications

9. Into multidisciplinary existing hospital committees Nursing Leadership Committee meetings Medical Staff Committee meetings Nursing Educators trained in CPOE Set up mandatory training for all staff Nurse managers and nurse educator identified staff and personally discussed and promoted staff involvement in CPOE implementation How We Integrated CPOE

10. Go live support 24 hour on campus support for 3 weeks (Consisted of Clinical IS staff, nurse educators and coaches) Set up a command center where all calls were diverted to for assistance regarding CPOE and distributed CPOE command center telephone number to all inpatient units and all outpatient areas. Nurse educator and several coaches carried cell phones utilizing text messaging to communicate where assistance was needed. This enhanced response time for the doctors and LIP's that were in need of assistance. Daily meetings to review prior days implementation, reviewed logged calls from LIP’s; and reviewed all logged issues to resolve them. Put out flyer updates to coaches to educate the staff regarding any changes made to the CPOE environment. Disseminated a schedule of coaches available to all managers for all 3 weeks, coaches were identified by a light blue t-shirt. Coaches decreased anxiety as the end user knows there is someone available for support

11. Continuous Improvement and Evaluation Conditions of employment that requires utilization of CPOE Establishing and measuring baseline measures of effectiveness Performing audits after the implementation of applications and providing refresher training for staff as necessary. Expectation that staff must achieve an 85% level of competency prior to implementation of any new application.

12. Initial Results • January 5, 2010 the first forty eight hours of implementation, there was 100% compliance. March 2010 • Since implementation there have been 17,043 orders. Out of these, only 2.3% are verbal or phone orders. • Medication errors were reduced by 40%. • There is increased efficiency of the medication administration order and delivery process, reducing the time from physician order to delivery of medication to the patient by 50%.

13. July 2010 • 44% reduction in raw number of medication errors that reached the patients in the 6 months after CPOE vs. 6 months prior to CPOE and a 62.5% reduction in our medication error rate.

15. Quotes • “CPOE has allowed me the ability to view all of my patient’s charts, at my finger tips, before I had to go get the chart, flip through a lot of paper, and obtain only the minimum amount information necessary to treat my patient.” • “I am so excited I am able to cover my on call rotation and place the orders from my home in my pajamas!” • “I was able to place and search orders on all my patients on the unit in a matter of two minutes; prior to CPOE it would have taken twenty minutes” • “The at the elbow support of the coaches has truly made a difference”

16. Lessons learned Leadership Commitment, Support and Active Involvement IS A MUST HAVE Planned/Staged Implementation of the Milestones Dedicated Staff with subject matter expertise actively engaged in every aspect of the project. (Providers, Nurses, Unit Secretaries, Educators, etc….) Effective Communication Plan that requires regular updates and reaches all staff affected by the process Dedicated Coaches engaged as support for training and implementation. Coaches that are providing at elbow support can not be included in direct patient care count. Something to think about is going Live with the complete system versus staged implementation of each paper item to computer?

17. Interview with nurse educator for CPOE Champion doctors and LIP’s Literature review References