CPOE Compliance Optimizes Patient Safety at Holy Family Memorial Medical Center
(6/24/2008)

Achieving a 100% physician compliance rate in CPOE requires dedication and planning, but the payoff is substantial in the long run. Just ask the folks at Holy Family Memorial Medical Center (Manitowoc, WI), who transitioned to MEDITECH's Provider Order Management (POM) through a "phased rollout" implementation. Their methodical approach to implementing CPOE helped the organization to overcome the potential challenges associated with switching from paper to electronic ordering. Ed Bauknecht, director information systems, credits this rollout approach for the smooth transition, and with each unit's rollout, physicians saw the results of improved quality care for themselves.

"Holy Family Memorial's number one goal is, and always has been, patient safety," says Bauknecht. "Although CPOE might not have the reputation of being the faster method for placing orders, it has proven to be the safer method—a huge selling point for our physicians and executives."

CPOE Rollout: One Unit at a Time
With 75 employed care providers, ranging from hospitalists to nurse practitioners, Holy Family Memorial decided a phased POM rollout would help ease their transition to CPOE. "In January 2004, our pilot unit, Medical Rehabilitation, went LIVE with POM. We selected it as our first unit, because it's a closed floor—meaning no patient transfers—and it has a dedicated medical director," says Jane Jaeger, clinical systems coordinator.

During Holy Family Memorial's CPOE implementation, departments in the 200-bed hospital sometimes processed orders both electronically and on paper. "In many instances, nurses who worked in these mixed environments had to remember which physicians placed orders electronically and which still used paper. Our CMO, Dr. Steven Driggers, mandated electronic order entry, thereby eliminating confusion, and ensuring all orders were properly followed," explains Bauknecht.

Prior to its CPOE implementation, Holy Family Memorial had all physician order sets on paper, enabling department heads to transfer order sets more easily to their POM solution. "Each department was well prepared for their CPOE go-LIVE, as their order sets were already entered into the system," says Jaeger. "Even today, if individuals edit any of the physician favorite or hospital-wide order sets, they communicate these changes to us."

Achieving Physician-Wide Compliance
Holy Family Memorial continues to expand on MEDITECH solutions, because the physicians have proven they're dedicated to utilizing technology for improved patient safety. "Prior to our POM implementation, the physicians had a good handle on Patient Care Inquiry (PCI)," explains Jaeger. "Providers were accustomed to using PCI and knew its benefits, so our next step was electronic signature implementation, which was mandated a few years later. When we turned our focus to CPOE, we were confident the physicians would be on board."

Jaeger says the physician advisory committee and physician champions also played a pivotal role in bolstering physician adoption during the POM rollout: "Dr. Larry Verlinden presented to several physician and support groups throughout the hospital, highlighting our current state, future goals, and the approximate timeline for going LIVE with CPOE. Dr. Verlinden's enthusiasm and support ensured everyone was on the same page with CPOE."

Based on recommendations from MEDITECH's implementation team, Holy Family Memorial also created a "pre-CPOE" and "post-CPOE" worksheet; nurse and physician groups used these tools to help alleviate any workflow disruptions during the transition. "With any implementation, there is a transition period from the old to the new process. We used these worksheets as guides to help staff adjust to the new workflow, and made adjustments based on how the go-LIVE went for each unit," says Jaeger.

Checkpoints Ensure Patient Safety Standards are Met
Since its CPOE implementation, Holy Family Memorial continues to assess quality, ensuring its patient safety standards are aligned with benchmarks established by The Leapfrog Group, The Joint Commission, and other national organizations.

"Bundling CPOE, Bedside Verification (BV), and Electronic Medication Administration Record (eMAR) enables Holy Family Memorial to establish numerous patient safety checkpoints," says Jaeger. "As soon as medication orders are placed, the system requires nurses to acknowledge the orders. At the same time, the Pharmacy also verifies medications to avoid any adverse drug reactions. The seamless integration of our MEDITECH system enables all staff members to communicate with one another, so we are proactively providing the highest quality of care.

"Within the first year of our CPOE go-LIVE, we evaluated the number of incidents over that period and compared them to our patient safety standards. We were pleased to find we not only met our goal, but also improved our level of patient safety. Electronic ordering has eliminated errors related to wrong patient/wrong dose, as well as errors from misreading handwritten orders."

Future Goals: Patient-Centric Care Across the Continuum
Holy Family Memorial recently implemented Physician Documentation. "Of all the MEDITECH products we've implemented, Physician Documentation is one of their favorites, because the physicians can document on and monitor patients' progress from the hospital or the clinic," says Jaeger.

Presently, 55 physicians throughout Holy Family Memorial are using 64 Physician Documentation templates, the majority being progress notes. "During the first phase of our implementation, we focused on progress notes, since they were the only parts of the record physicians could not access electronically," says Jaeger. "The next implementation phase will include Emergency Department documentation, as well as hospital summary and consults documentation."

Holy Family Memorial continues to work with MEDITECH's Advanced Clinical Systems group to evaluate their current suite of software solutions, and to explore options for optimizing care delivery. Most recently, with the implementation of LSS Data System's Electronic Ambulatory Record (EAR) across four affiliated physician clinics, Holy Family Memorial's exceptional patient care is not restricted to the confines of the hospital.

On the continued expansion of their MEDITECH/LSS solution, Bauknecht says, "Our partnership with MEDITECH and LSS is a strong one of necessity. These integrated systems heighten the safety and quality of care we deliver to our patients, and enable us to better monitor care throughout the continuum."

 

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