MD orders via computer

Overland1, RN · Mar 9, 2011

OK, this may have been covered in another thread, sorry if it's repetitive.
Recently the policy at the facility in which I work has the doctors entering orders in the computer, as opposed to the paper chart.
Nurses were told, "Be extra careful checking orders!" So I have to take the computer's word for it. Scary to me.
Last week, a consulting physician even called the attending to ask if one order was correctly entered, it seemed an inappropriate order.
Does anyone else have experience with this? Does anyone else think this unsafe?

Hey... just about anything and everything can be considered "unsafe", but the basic rules and concepts should still apply. If you see an order that appears to be wrong, inappropriate, or potentially harmful to the patient, you should question that order, regardless of how it was entered and who entered it.

My facility will eventually be switching to order entry by physicians (phone orders will have to be electronically signed by the respective physicians), and there will be numerous means of checking them before the doc completes the process. It will be tied to the hospital's formulary and flag anything that seems out of whack.

azhiker96, BSN, RN · Mar 9, 2011

I think the computerized orders are much safer than the old hand written orders. I wish I'd saved a couple of samples to show newer nurses. We used to get 2-3 nurses together to try to decipher some of the script. There were a few experts on one or another doctor's handwriting and that helped.

Then, as now, there were occasional orders that were not appropriate for the patient. We still need to use critical thinking and raise the issue when we find it. I must say most of the doctors I know are very good but sometimes they have a new resident or PA who may miss something.

Bruce_Wayne, ASN, RN · Mar 9, 2011

One advantageous computer orders have other written orders is that the computer will prompt the user about all the necessary things of the order. So if there's a Q weekly medicine for example, a common error would be to not include what day to start the medicine, the computer would prompt the doctor right then and there to pick a day to give the drug. I think also computers can be programed to show common doses and interactions so once people get used to them they're safer.

classicdame, MSN, EdD · Mar 9, 2011

Are you implying someone else could be writing the order besides the MD? That is possible, but not something you have control of anyway. As always, make sure the order is appropriate for the patient. Use your chain of command if you suspect anything fishy

JoMark06 · Mar 9, 2011

I started my nursing career at a facility that used (almost) 100% paper charting, to include orders entered either by a doctor or by a RN entering it as a verbal/telephone order which the doc will later electronically sign. I recently switched jobs to a facility that uses a combination of paper and computer charting where the orders are paper charted and transcribed into the computer by pharmacy (for med orders) and unit secretaries/nurses (for lab orders and other tests). I personally think the orders being entered directly into the computer is much safer. I hate having to decipher the docs' handwriting. It's unsafe and time consuming. When I was given a verbal or telephone order to enter into the computer, I was required to do the same as with any system of taking orders...read back and verify.

meandragonbrett · Mar 9, 2011

OK, this may have been covered in another thread, sorry if it's repetitive.
Recently the policy at the facility in which I work has the doctors entering orders in the computer, as opposed to the paper chart.
Nurses were told, "Be extra careful checking orders!" So I have to take the computer's word for it. Scary to me.
Last week, a consulting physician even called the attending to ask if one order was correctly entered, it seemed an inappropriate order.
Does anyone else have experience with this? Does anyone else think this unsafe?

What do you mean you have to take the computer's word for it? It's no different than "Taking the paper's word for it" when you had orders written on paper.

Why do you feel that it's unsafe? It's no less safe than having written orders and trying to decipher the handwriting at 2am.

HouTx, BSN, MSN, EdD · Mar 9, 2011

Change is hard, isn't it? I started back in the days when we "poured" meds for the patient in a med room and mixed all of our own IVF. I remember some of the same comments. You would have thought it was the end of the world when we switched to unit dose & had to "trust" the pharmacy to mix our IVF. And don't even get me started about having to learn to start IVs with gloves on... that's right, I'm really that old - LOL. I wonder if it's our educational process that imbues us with such a sense of paranoia... "I don't trust anyone but me to do it right", whether it's giving a bed bath or ordering meds.

I am currently involved with CPOM initiatives (computerized provider order management) and have come to realize that the docs are even more hesitant than we are. But it isn't so much that they don't trust the technology - they are afraid of appearing incompetent in front of us 'lesser beings' as they try to become proficient tapping away at the keyboard and clicking that mouse. Just grab a life raft & scooch over to make room for others - we're all in the same boat.

blondy2061h, MSN, RN · Mar 9, 2011

We've been doing computer order entry for years now. I LOVE it. No more interpreting handwriting. the computer only let's them order forms of the med available, so no silly orders like for "IV tylenol." The computer automatically checks for allergies, and drug interactions, and questions insane doses before the order is even in, so you're not calling the doctor about that. The pharmacy gets the order the same time you do, no more faxing it down there after you signed it off. The doctors can do it from home, so no trying to hear a crappy cell phone connection. I love it. I think you're way more likely to run into problems with a paper order. It's just a matter of seeing if the drug/dose/route etc makes sense for the patient. I don't see how you're taking a computer's word for anything.

Just a few days ago I got an admit and had the attending for her service call me from home and say, "Hey, I just put some orders in for Mr. Newpatient. I didn't have to waste time when I was busy taking and entering phone orders. Also this week I had a doctor miss a silly, non-urgent order on an admit. I e-mailed him about it and he entered the order next time he checked his e-mail.

pajoopie1 · Mar 9, 2011

I love computer-physician order entry. Studies show that it decreases med errors, for all the same reasons mentioned in other posts.

JulieCVICURN, BSN, RN · Mar 10, 2011

I recently became the clinical informaticist for my facility and I'm responsible for a project to implement the order entry for physicians. I hear many of the same concerns you wrote, and in my limited experience and research, I'm absolutely convinced that this is a much safer way of doing things for patients. It may take more time sometimes, it may get frustrating when your systems go down, but ultimately it's the safest, best thing for the patients.

gracedRN, BSN, RN · Mar 10, 2011

It is good and a relief to read positive experiences with computer generated orders.