CPOE in the ED

[Clinical IT nurse 09]

Hello. We currently use CPOE on our inpatient side in the hospital I am employed at. We have moved towards using it in the ED also, but several of the physicians are claiming it is slowing them down too much for an ED setting. They are now requesting to have a "scribe" for them in the ED, which they say is to be a nurse that will put in all their orders for them.

Just wondering if anyone else out there is using this method. If so, do you put them all in as verbal orders and let the physician sign them later? If not, how do the orders get put in electronically?

Any insight would be very much appreciated.

thank you

**I also posted this on the Nursing informatics page**

[Penguin67]

My first thought is that the physicians are being lazy, by wanting a "scribe". If it slows them down, think of how it will slow a nurse down, as well.

My second thought is that there is an obvious learning curve here, and they need to be assured that they will be assisted through the learning curve with tech support, not a scribe, present for about 1-2 weeks when first implemented.

Having a nurse scribe can lead to med errors, as the person who gives the orders should also be the person writing the orders.

When a hospital that I used to work at first implemented computer orders, it was a controlled chaos situation. We were all on edge, but it worked itself out, as tech support was present on the unit for one solid week to assist immediately, since you can't learn everything in one class. And, there were "champion" users on each unit who were the smart superusers who could help us after teach support left, and we could call the tech support desk anytime we needed assistance.

Giving the physicians a scribe will never allow them to elarn the system and will be a permanent burden for nurses. Make sure you guys make the physicians stand on their own two feet! And if it takes too much time for them to do it, then don't do it!

[mwboswell]

They won't get a scribe for CPOE.

CPOE is "standard" pretty much now where ever you go.

However using a scribe to chart the H/P is a different story.

Many places are doing this, and yes, it is done to maintain speed of throughput in the ED.

Ideally it is done with the scribe charting the HPI and the Physical exam, while the MD/NP is doing the exam. During the exam they are calling out the physical exam findings. The scribe also acts like a transcriptionist during the "interview" part of the exam. The whole point is that immediately after finishing the exam, they can walk right out of that room and into the next room without having to sit and "chart".

This does not mean they see the pt then go put their feet up!

-MB

[canoehead, BSN, RN]

They have to do like all other employees when change comes around and suck it up!