Impact of a computerized physician order entry system on nurse-physician collaboration in the medication process.
BACKGROUND
Due to their efficiency and safety potential, computerized physician order entry (CPOE) systems are gaining considerable attention in in-patient settings. However, recent studies have shown that these systems may undermine the efficiency and safety of the medication process by impeding nurse-physician collaboration.


OBJECTIVE
To evaluate the effects of a CPOE system on the mechanisms whereby nurses and physicians maintain their collaboration in the medication process. SETTING AND METHODOLOGY: Six internal medicine wards at the Erasmus Medical Centre were included in this study. A questionnaire was used to record nurses' attitudes towards the effectiveness of the former paper-based system. A similar questionnaire was used to evaluate nurses' attitudes with respect to a CPOE system that replaced the paper-based system. The data were complemented and triangulated through interviews with physicians and nurses.


RESULTS
Response rates for the analyzed questions in the pre- and post-implementation questionnaires were 54.3% (76/140) and 52.14% (73/140). The CPOE system had a mixed impact on medication work: while it improved the main non-supportive features of the paper-based system, it lacked its main supportive features. The interviews revealed more detailed supportive and non-supportive features of the two systems. A comparison of supportive features of the paper-based system with non-supportive features of the CPOE system showed that synchronisation and feedback mechanisms in nurse-physician collaborations have been impaired after the CPOE system was introduced.


CONCLUSIONS
This study contributes to an understanding of the affected mechanisms in nurse-physician collaboration using a CPOE system. It provides recommendations for repairing the impaired mechanisms and for redesigning the CPOE system and thus for better supporting these structures.
Pirnejad
Habibollah
H
Healthcare Governance, Department of Health Policy and Management, Erasmus University Medical Centre, Rotterdam, The Netherlands. h.pirnejad@erasmusmc.nl
Niazkhani
Zahra
Z
van der Sijs
Heleen
H
Berg
Marc
M
Bal
Roland
R
D000328:Adult; D001291:Attitude of Health Personnel; D001292:Attitude to Computers; D003144:Communication Barriers; D003299:Cooperative Behavior; D003430:Cross-Sectional Studies; D020000:Decision Support Systems, Clinical / Q000706:statistics & numerical data; D004360:Drug Therapy, Computer-Assisted / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D050316:Medical Order Entry Systems / Q000592:standards / Q000706:statistics & numerical data; D008508:Medication Errors / Q000517:prevention & control / Q000706:statistics & numerical data; D008875:Middle Aged; D004364:Pharmaceutical Preparations / Q000008:administration & dosage; D019555:Physician-Nurse Relations; D017751:Safety Management / Q000458:organization & administration
D004364:Pharmaceutical Preparations