Communication among care providers and critical thinking do not stop when a computer system starts.
So, picking up where we left off in Part 1 of CPOE-induced Communication Breakdown, I wanted to provide some examples in Part 2.
(1) CPOE mandated in an academic medical center. Physicians are entering orders at an amazing rate and the culture is transforming. The nurse responsible for the patient, having diligently attended training and asked all the right questions, is utilizing the computer system and the new whiz-bang Task List (as a professional nurse, I’ve always hated the notion of my list of “tasks” but had to finally give in and admit that, yes, I perform tasks for my patient – tasks that require critical thinking skills and advanced education but tasks nonetheless, but I digress…..).
Suddenly the flag appears on the “New Orders” column for an IV at 125ml/hr…….the patient has known CHF – what the heck?? The nurse tracks down the ordering physician (a new, energetic resident on July1st….) and a discussion ensues on the topic of the delicate fluid balance in the older cardiology population and the IV is discontinued.
While there were valid reasons why this was an appropriate order for this patient, and thus no automated alerting, there were also valid reasons why it was not appropriate. Had the nurse and the physician had a five minute discussion, this would’ve been avoided. Communication among care providers and critical thinking do not stop when a computer system starts.
(2) The new CPOE system is installed and an initial ‘soft’ go-live with only nursing, clerks and pharmacy utilization. All have attended training and feel comfortable that they know how to use the system to process the physician’s written orders. While rounding on the floors during this ‘soft’ go-live, the following question was posed: “This patient is discharged, where is the communication order to the patient’s nurse to let them know?”
OK, let’s think about this for a moment……you want to enter a “communication order” to communicate the patient discharge to the patient’s nurse?? By now, the patient has likely already mentioned it a thousand times without the aid of any kind of “communication order”. What happened to good, old-fashioned talking to each other?? Communication among care providers and critical thinking do not stop when a computer system starts.
(3) The new CPOE system is installed and the physicians are actively engaging in the automation of order management. The practice of consulting a specialist colleague is common in healthcare and this is, of course, an option in the new CPOE system. When the order is placed, there is a message sent electronically as well as a printed requisition that is routed to the specialist colleague’s office.
Stay in your seats, folks, there’s more! Often a call (i.e. communication) is required to ensure that the receiving office is aware of the requested consult. The request will appear on an electronic task list but it is often recommended that a verbal communication (i.e. talking) take place to ensure that the receiving physician is aware of the pending consult seeking his or her expertise. Communication among care providers and critical thinking do not stop when a computer system starts.
We are experts in the industry and as we engage in any type of healthcare IT project, we need to keep in mind that our constituents are typically not as comfortable with technology as we are, and very likely will have a skewed sense of what the computer can and cannot do for them. Part of our consultative role, in addition to the nuts and bolts of an implementation or a system assessment, should be to ensure that our clinicians have a realistic understanding of the benefits of automation while maintaining a healthy respect for good old-fashioned face-to-face talking and keeping real time communication “real!”