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1. Customisation for use with children
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14
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The risk of failing to customize existing systems to assist with prescribing for pediatric patients is likely substantial.
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2 of the 3 studies with negative findings were not customised for use with children. The evaluation in the 3rd study was not designed to test the impact of package type on prescribing.
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(Holdsworth et al. 2007, p. 1064) [32]
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2. Stakeholder engagement
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9
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Active involvement of our intensive care staff during the design, build, and implementation stages … are prerequisites for a successful implementation.
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None of the 3 studies with findings of harm described a stakeholder engagement process.
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(Del Beccaro et al. 2006, p. 294) [30]
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3. Fostering familiarity
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13
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Probably the most important and fundamental activity necessary for a smooth transition to CPOE is staff CPOE training … Poor training may lead to a lack of system understanding, which can result in frustration, poor acceptance, and a lack of full utilization.
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The training provided in the Han et al. study has been identified as inadequate, and no training was described in the other 2 studies with harmful outcomes. Studies measuring at multiple time points show greater benefits at later follow-up.
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(Upperman et al. 2005a, p. e639) [44]
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4. Adequate/appropriate infrastructure
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6
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Our finding [of an increase in mortality] may reflect a clinical applications program implementation and systems integration issue rather than a CPOE issue per se.
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The Han et al. study acknowledges that the harmful outcomes observed were likely due to infrastructure problems rather than EP itself.
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(Han et al. 2005, p. 1511) [31]
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5. Planning and iteration
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14
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It is important for hospitals to monitor, continually modify, and improve CPOE systems on the basis of data derived from their own institution.
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There was a relatively limited (3 months) preparatory phase in the Han et al. study in comparison to other studies.
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(Walsh et al. 2008, p. e427) [46]
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