Emergency Department prepares for CPOE launch

Each day brings new challenges to our Emergency Department team. The doctors, nurses, clerks and technicians on duty never know whether the next event will be a car crash, heart attack, hunting accident or some other emergency. But here’s a challenge they can well anticipate: On Oct. 27, the emergency departments at Christiana Hospital and Wilmington Hospital will launch computerized order entry and medication administration systems designed to reduce errors and enhance patient safety.

To prepare for the transformation, a dedicated multidisciplinary team is helping the Emergency Department staff to build experience before the system goes live, using a closed-loop, power-chart environment that simulates a random variety of patient scenarios.

Although there are always a few bumps in the road, abundant preparation and cooperation in the Emergency Department will help to smooth the transition, said Terri Steinberg, M.D., MBA, chief medical information officer.

The initiative has been a monumental undertaking at two busy Emergency Department facilities. Wilmington Hospital’s ED served 52,800 patients last year. More than 112,500 patients received emergency care at Christiana Hospital—one of the highest-volume EDs in the United States.

“The Emergency Department at Christiana Hospital is as big as many small hospitals,” said Charles L. Reese IV, M.D., chair, Department of Emergency Medicine. Christiana Hospital’s 65-bed ED typically treats 320-370 patients each day.

“There is no limit to how many patients we might have to treat at any given time,” said Linda Laskowski-Jones, RN, MS, ACNS-BC, CEN, vice president, Emergency, Trauma and Aeromedical Services. “That is why we are working very hard to structure the eMAR/CPOE system to expedite patient care. We have to have medications and get them to the patients right away.”

In the EDs, the CPOE system has been modified to permit most medications to be dispensed without the time-consuming review and verification process applied in the rest of the hospital. Nurses enter patient allergies on a computerized assessment sheet before medications are ordered. Through a hand-held barcode-reading device, eMAR enables a nurse to scan both the patient and the drug to make certain the right patient is receiving the correct medication.

“Implementation of CPOE and eMAR will transform the way we provide care to our patients in the ED by significantly reducing the risk of medication and order entry errors,” said Heather Farley, MD, FACEP, assistant chair, Department of Emergency Medicine. “Our multi-disciplinary implementation team has worked hard to ensure that electronic processes will not inhibit time-critical actions for emergency patients.”

The ED will not become completely paperless. Orders for patients presenting with time-critical emergencies will continue to be processed by hand.

“We can’t get them medications fast enough through CPOE, so we will continue with the system that is in place for those very sick patients,” Laskowski-Jones said.

According to Dr. Reese, those successful launches have helped to ease the way for the latest initiative. “Plus, we are used to dealing with something new every day in the Emergency Department,” he says. “Culturally, that will work in our favor.”