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.
Conclusion
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.