Beam Kristyn S, Cardoso Megan, Sweeney Megan, Binney Geoff, Weingart Saul N
Kristyn Beam, MD, Department of Pediatrics, Floating Hospital for Children, Tufts Medical Center, 800 Washington Street, Boston, MA 02111, Phone: 704.699.4744, Email:
Appl Clin Inform. 2017 Apr 5;8(2):337-347. doi: 10.4338/ACI-2016-09-RA-0153.
Computerized provider order entry (CPOE) is a technology with potential to transform care delivery. While CPOE systems have been studied in adult populations, less is known about the implementation of CPOE in the neonatal intensive care unit (NICU) and perceptions of nurses and physicians using the system.
To examine perceptions of clinicians before and after CPOE implementation in the NICU of a pediatric hospital.
A cross-sectional survey of clinicians working in a Level III NICU was conducted. The survey was distributed before and after CPOE implementation. Participants were asked about their perception of CPOE on patient care delivery, implementation of the system, and effect on job satisfaction. A qualitative section inquired about additional concerns surrounding implementation. Responses were tabulated and analyzed using the Chi-square test.
The survey was distributed to 158 clinicians with a 47% response rate for pre-implementation and 45% for post-implementation. Clinicians understood why CPOE was implemented, but felt there was incomplete technical training. The expectation for increased job satisfaction and ability to recruit high-quality staff was high. However, there was concern about the ability to deliver appropriate treatments before and after implementation. Physicians were more optimistic about CPOE implementation than nurses who remained concerned that workflow may be altered.
Introducing CPOE is a potentially risky endeavor and must be done carefully to mitigate harm. Although high expectations of the system can be met, it is important to attend to differing expectations among clinicians with varied levels of comfort with technology. Interdisciplinary collaboration is critical in planning a functioning CPOE to ensure that efficient workflow is maintained and appropriate supports for individuals with a lower degree of technical literacy is available.
计算机化医嘱录入（CPOE）是一项有可能改变医疗服务提供方式的技术。虽然CPOE系统已在成人患者群体中得到研究，但对于其在新生儿重症监护病房（NICU）的实施情况以及使用该系统的护士和医生的看法了解较少。
研究一家儿科医院NICU实施CPOE前后临床医生的看法。
对一家三级NICU的临床医生进行了横断面调查。在CPOE实施前后分别发放调查问卷。询问参与者对CPOE在患者护理提供、系统实施以及对工作满意度的影响方面的看法。定性部分询问了围绕实施的其他问题。使用卡方检验对回答进行列表和分析。
共向158名临床医生发放了调查问卷，实施前的回复率为47%，实施后的回复率为45%。临床医生理解实施CPOE的原因，但认为技术培训不完整。对提高工作满意度和招募高素质员工的期望很高。然而，对实施前后提供适当治疗的能力存在担忧。医生对CPOE实施比护士更乐观，护士仍担心工作流程可能会改变。
引入CPOE是一项潜在风险较大的工作，必须谨慎进行以减轻危害。虽然该系统的高期望可以实现，但关注不同技术水平临床医生的不同期望很重要。跨学科合作对于规划一个有效的CPOE至关重要，以确保维持高效的工作流程，并为技术素养较低的个人提供适当支持。
