Inpatient verbal orders and the impact of computerized provider order entry

Objective

To describe the characteristics of verbal orders at a tertiary care children’s hospital.

Study design

Between August 2003 and January 2004, the computerized provider order entry (CPOE) system was evaluated for the characteristics of verbal orders. The rate of total orders represented by verbal orders and the rate of unsigned verbal orders were examined before, during, and after CPOE implementation.

Results

After CPOE implementation, a mean of 19,996 ± 521 orders were generated weekly; of these, 2094 ± 65 (10%) were verbal orders. The greatest rates of verbal orders were from psychiatry (74%) units and involved medication orders (38%; 790/2094). The greatest rates of medication verbal orders were psychotherapeutics (24%; 662/2697). Medical physicians had a larger rate of verbal orders than surgical physicians. The rates of verbal orders and unsigned verbal orders were reduced from 23% and 43% before CPOE implementation to 10% and 9% after implementation, respectively.

Conclusions

Medication orders from physicians to nurses are the primary source of verbal orders in this tertiary care children’s hospital. CPOE implementation significantly affected both verbal orders and the rate of unsigned verbal orders. This type of data is important for institutions aiming to decrease verbal orders and associated medical errors.

Abbreviations: CCHMC, Cincinnati Children’s Hospital Medical Center, CPOE, Computer Provider Order Entry, ICIS, Integrating Clinical Information System, JCAHO, Joint Commission on Accreditation of Healthcare Organizations, MAR, Medication administration record, NCC MERP, National Coordinating Council for Medication Error Reporting and Prevention, NDC, National Drug Code