Example: discussion post

Discussion Board Examples

This example is included in the syllabus:
DISCUSSION BOARD EXAMPLES
Discussion assignment provided by instructor:
An academic health center (AHC) with a large cardiovascular inpatient center states that it has adopted Computerized Physician Order Entry (CPOE)  in compliance with the 100,000 Lives Campaign initiatives.  In 2007, you are retained by the AHC as a consultant for the new 5 Million Lives Campaign.  As one of your information gathering activities, you meet with the nurses on the cardiac care unit.  They laugh and are sarcastic about the CPOE system and with probe questions you learn:  1) the CPOE software does not “talk” to the pharmacy’s software resulting in a pharmacy tech reentering the orders by hand every 24 hours  2) the interns and residents often forget to plug the CPOE cart in to recharge and the battery runs down.  There is talk of assigning “plugging in” to the nursing staff and 3) now that physicians interface with the CPOE system, they often spend their limited time reading data from the computer and do not go in to see, speak or assess patients except for morning rounds or when confronted by a nurse.  Discuss this scenario in terms of dynamic complexity, the claim that CPOE is effective in this hospital, patient safety, workflow, core processes, the Shewart Cycle, FMEA or Magnet hospital criteria. 
Generative answer for this assignment (5 points):
Your posting made me think about tight coupling. It looks like this system becomes “uncoupled” if the tech is only entering orders once every 24 hours. What is happening to the patient? Are they missing doses between times?   Or, have we created some manual work around to get the medications up to the floor before they are in the pharmacy system? Reading into this imaginary situation, this is a very likely possibility. This plays into trade-offs – the costs of continuing to do what we do and paying for an interface. We may have “found money” to pay for the costs of interfacing the systems. A manual workaround is expensive in terms of staff and introduces chances for patients to not be billed and inventory not to be tracked (causing out-of-stocks), or vice versa, double billed or inventory relieved twice (causing over-stocks). So we may have missed revenues or extra costs far beyond the costs of the one tech keying in the orders.
Collaborative answer for this assignment (10 points)
CPOE (Computerized Physician/Provider Order Entry System) has been shown to reduce serious prescribing errors in hospitals by more than 50%. The fact that this software does not talk to the Pharmacy’s software is a big concern, especially if the Pharmacy tech has to reenter the orders by hand every 24 hours. The purpose of CPOE is to minimize human hands.
Human system is complex and variable that requires complex and variable management according to the vital signs, laboratory results, age, sex, weight, route, contraindications, interactions, and co-morbid conditions. It is very important that CPOE software should interact with pharmacy software. I would further argue that it should interact with computer assisted management program, where software also uses the clinical evidence and the costs of optional therapies. The software program also continuously updates the most current version of all the necessary decision elements (patient, medical evidence, cost, and safety consideration), and presents the information to the care providers at the time of service, so that they may make timely decisions about the most appropriate, safe, and cost effective intervention (Evans et al. 1998; Mullett et al. 2001).
Based on the above information I would argue that CPOE would be effective in this hospital for patient safety. It will also improve the workflow, as nurses do not have to carry orders to the pharmacy, which will save time and help nurses to spend more time with the patients.
It improves the core processes by improving clinical/medical process through provision of safe, effective medicine (improving conversion process) and thus leading to excellent clinical outcome (outputs).
Shewhart Cycle- CPOE helps the providers to devise the plan after the provider gathers subjective data and enters objective data (vital signs, physical exam etc.), and devise a patient plan on the data by selecting medication, implement the plan, evaluate the plan and revise the plan as needed (increase or decrease or change to new medication). This scientific method is also called professional judgment (Facione et al.2005).
FMEA- Core processes for ordering medication have become enormously complex, and the risks of errors and process failures have grown in turn. Tools such as FMEA can identify potential failures in your own ordering processes and show you which practices to test first to reduce the risk in organization.
Charging of the CPOE cart is a technical problem, and could be solved technically. Where as the argument that provider spends less time with patient and more time with system is old. Spending more time with patients without having scientific data would not improve the outcome. Spending adequate time with patients to collect subjective data should be encouraged.
To save an estimated 122,000 lives in 18 months in 100,000 Lives campaign, in 3,100 hospitals is a remarkable goal and Five Million Lives Campaign is a step forward and represents CQI and ultimately improving total quality (TQ).
This entry was posted in Uncategorized. Bookmark the permalink.