Computerized provider order entry (CPOE): How is nursing work impacted?

摘要

The purpose of this dissertation is to compare nursing work in intensive care units (ICUs) that have implemented computerized provider order entry (CPOE) with ICUs that have not in order to identify the potential effects of the CPOE system on nursing work. Most nursing information system research focuses on those designed for use by nurses (e.g. clinical documentation systems). The introduction of a clinical information system designed for use by another worker in the same workplace, such as a CPOE system designed for use by prescribers, may have an as yet unexplored impact on the nurse.;This study utilizes a case study design with the Activity theory providing the structure to organize the data collection, data reporting, and data analysis according to the six concepts of work: role, person, environment, organization, task, and technology. Data were collected in two paper-based ICUs and two CPOE ICUs. The data includes interviews and observation of tasks with clinical nurses (8 paper-based, 9 CPOE) and interviews with nursing leaders (3 paper-based, 3 CPOE) and IT implementation personnel (3 paper-based, 2 CPOE).;The case studies included the results from the observations and interviews and indicate that although nurses on both units spent most of their observed time in the same groups of tasks of conversational, patient care, and documentation, the relative amount of time in all tasks is different between the two units (Wilcoxon-Mann Whitney rank sum test = -6.96, p0.01). Closer inspection revealed differences in communication with prescribers and other hospital personnel (relative rank higher in ICUs that have implemented CPOE and those that have not), and adds to the literature on the impact of technology on nursing work by providing a more granular enumeration of nursing tasks than has been previously reported.;Future work should extend the examination of the impact of IT on nursing work to also include evaluation of the clinical outcomes achieved under different technology conditions.;Keywords: Nursing informatics, CPOE, nursing work, Activity theory, nursing leadership, nursing tasks, work sampling.