Pediatric Informatics: Computer Applications in Child Health (Health ...

8 Complexity in Healthcare Information Technology Systems 97
Table 8.1 (continued)
Implementation problem Assessment of risk Possible prevention strategy
All new medication orders
require activation from
nursing
Workflow
Face to face communication
between doctor and nurse
decreased noticeably
Orders remain pending
until nursing approval
resulting in delayed
care. Nurses are forced
away from the bedside
to perform cumbersome
medication activation
procedures
Unaware of placed orders,
nurses did not sign off
on medication orders in
a timely fashion. This
compounded the delay
in therapy secondary to
the order activation procedure
and led to delay
in patient
Technical
Limited wireless bandwidth Frequent system hangs and
long order processing
Concurrent deployment
of clinical applications
platform
Implementation occurred
over a 6 day period on
all units (“Big Bang”
approach)
Institutional
Pharmacy was moved out
of the ICU and into
centralized location
without prior time delay
and process throughput
testing
times delay patient care
The adult focused clinical
applications platform
may have conflicted
with CPOE reducing
performance
Rapid implementation did
not allow for identification
and repair of critical
system problems before
moving to other units
Long lag time between
medication ordering and
delivery to bedside
Careful workflow analysis
prior to implementation will
identify potential workflow
concerns
Allow medication to activate
upon ordering
CPOE training must educate
providers that CPOE is a
tool, not a substitute for
personal interactions with
nursing and other allied
health professionals.
Clinical decision support that
pages providers if orders
remain unacknowledged
Careful technical analysis and
testing under maximal load
is essential prior to “go live”
Implement critical systems
one at a time and ensure
adequate error testing and
quality assurance
Implementation is an iterative
process. Begin with
general pediatric floors
and correct all identified
problems
Implement subsequent units
over months
Continuous support during
critical “go live” phases is
required
Unit based pharmacies have
been independently
associated with faster
drug administration
and lower ADE rates. In
pediatric ICUs unit-based
pharmacies can be life
saving in the event of
system failures
Simultaneous implementation
and physical layout changes
must be avoided