Because of the wide scope of family medicine, we cared for patients with a wide variety of medical conditions. [14, 15] Two observational studies have demonstrated that order sets likely improve the quality of hospital care for patients with AECOPD and reduce LOS. Stroke order set use not mandatory for physicians, so adherence may have been an issue. In another pre-post study of older adults (over 45 years) with AECOPD, there was no difference in median hospital LOS between pre- and post-implementation.19 A subset analysis in which only included patients that had the order set used in their care compared to patients that did not have an order set used found a significant difference in LOS, favouring the order sets (adjusted median difference in days 0.73, 95% CI 1.40, 0.07). The copyright and other intellectual property rights in this document are owned by CADTH and its licensors. Reducing pediatric asthma hospital length of stay through evidence-based quality improvement and deployment of computerized provider order entry. Appendix 4 presents a table of the main study findings and authors conclusions. The included non-randomized studies were critically appraised using the Downs and Black Checklist.6 Summary scores were not calculated for the included studies; rather, a review of the strengths and limitations of each included study were described narratively. the antibiotic/insulin order in as a stat order separately) i. Adaptation and implementation of standardized order sets in a network of multi-hospital corporations in rural Ontario. SOSs differed in each study based on the indication or disease area they were intended to be used for. Our physicians are not need to use orders for every admission Each patient presents with a exclusive situation both should be address accordingly at that physicians discretion. Eight SOSs were delivered in an electronic format,10,1417,19,21 with six studies exclusively including an SOS in a CPOE.9,1517,19 Three studies used a combination of paper-based and electronic SOSs,12 or originally started with paper-based SOSs and switched to electronic during the study period.13,20 Two studies used exclusively paper-based or pre-printed SOSs.8,18 One study did not specify the format of the order set.11, All studies compared SOSs to ordering without a SOS.821 The majority of these studies defined their comparator as no order sets, usual care, or pre-implementation.1012,1420 Two studies compared SOSs to non-standardized/diverse order sets,13 or handwritten orders,8 and one study compared SOSs within an electronic health record (EHR) to solely CPOE without order sets.21 One study compared SOSs within CPOE and EHR to solely EHR with no CPOE/SOS.9, Six studies reported on hospital length of stay,10,11,14,16,17,19 seven studies on readmission rates,10,11,13,14,16,17,19 and seven on mortality.810,16,17,19,21 Other reported outcomes included rate of prescribing errors,8,10 changes to symptom management or medications,18,20 appropriate medication dosages or monitoring,12,15,20 complications810,12 comfort at time of death,18 and hospitalization cost per patient.11. AS, Huang Edit the PDF document in the new dashboard which includes a full set of PDF tools. S, Fung What is the clinical evidence regarding the use of standardized hospital order sets in the acute care setting? Subject to the aforementioned limitations, the views expressed herein are those of CADTH and do not necessarily represent the views of Canadas federal, provincial, or territorial governments or any third party supplier of information. Accepted indications for long-term catheterization include: uncorrectable bladder outlet obstruction, intractable skin breakdown due to urinary incontinence, neurogenic bladder, and palliative care. This document may contain links to third-party websites. Implementation and evaluation of a diabetic ketoacidosis order set in pediatric type 1 diabetes at a tertiary care hospital: a quality-improvement initiative. Lau Obtain pertinent phone numbers for contacts and establish a decision maker within the family. As Ive mentioned in previous FPM articles, we do not view these as written in stone (see Using Standardized Allow Orders to Enhancing Inpatient Care, November/December 1999 and 30 Standardized Hospital Admittance Orders, October 2001). Confounding not considered nor adjusted for, Patient demographics reported and tested statistically between groups, Multivariate analysis used to test for association of factors that differed between groups to choose to use the SOS, and found to be not be significant, Multiple regression model used, and confounders adjusted for, No losses to follow-up due to study design, Some values differ between text and tables e.g., mean age of whole cohort transcribed as 62 in text and 69 in table, FEV1 score differ (55.1% vs. 53%). Active cancer (including patients with local or distant metastases or who within the past 6 months have had chemotherapy or radiotherapy), Previous VTE (excludes superficial vein thrombosis), Reduced mobility (includes bed rest with bathroom privileges for at least 3 days), Acute myocardial infarction or ischemic stroke, Acute infection and/or rheumatologic disorder. Ballard AB, Montero 9 potentially relevant publications were retrieved from the grey literature search for full text review. ~6010-D005, Critical Care Orders. Multiple results of one unique test reviewed at a visit count for one test. MS. AECOPD = acute exacerbation chronic obstructive pulmonary disease; CCI = clinical comorbidities index; CDST = clinical decision support tool; CMOS = comfort measures order set; CPOE = computerized provider order entry; ICD-9 = International Classification of Diseases, Ninth Revision; FEV1 = forced expiratory volume; LOS = length of stay; PICU = pediatric intensive care unit; SOS = standardized order set, N = 1494 visits total, 1223 unique patients, Period 3 (P3) - CPOE + SOS + discharge checklist, Period 4 (P4) - CPOE + SOS + revised checklist, CPOE month over month use rate was 83 to 89% (mean of 85%), Discharge checklist use rate increase 18% to 72%, LOS (geometric mean, hours), general linear model. We hope you find these orders helpful in your practice. The search strategy was comprised of both controlled vocabulary, such as the National Library of Medicines MeSH (Medical Subject Headings), and keywords. Strengths and Limitations of Clinical Studies using Downs and Black Checklist. CADTH does not make any guarantee with respect to any information contained on such third-party sites and CADTH is not responsible for any injury, loss, or damage suffered as a result of using such third-party sites. Appendix 1 presents the PRISMA7 flowchart of the study selection. Effectiveness of a standardized electronic admission order set for acute exacerbation of chronic obstructive pulmonary disease. KJ, DeRonne Those material may not otherwise be downloaded, copied, custom, stored, transmitted either reproduced in any medium, whether now known or later invented, except as authorized in writing by aforementioned AAFP. Changes are reviewed by the BHCS Pharmacy and Therapeutics and Patient Safety Committees. To help decay unnecessary variability int our caution, we designed an series on admission orders for common hospital admissions. The main search concepts were order sets and acute care. Specificity of the Order: The regulations at 42 CFR 412.3 require that, as a condition of payment, an order for inpatient admission must be present in the medical record. Flood Where possible, retrieval was limited to the human population. Means used with Mann Whitney U test, reasoning not explained, distribution of comorbidity data not discussed, Retrospective study design does not allow for control of potential confounding variables in the two groups, Relevant demographics information reported, Educational sessions used to explain proper use of order sets, Mean daily blood glucose adjusted for confounders, Multiple time points taken to adjust for temporal changes in daily glucose levels, Unit of analysis was hospital admission (readmission treated as separate data points), but standard errors were adjusted for the correlation of observations within individuals Intervention of interest described with attached order set, Single centre study may not be generalizable to other settings, Demographics information not statistically tested, Retrospective study design does not allow for control of potential unmeasured confounding variables in the two groups, No demographics were reported or compared. This comes checking certain orders with specialists in relative fields and modifying our orders to match any standing orders exhibited by his primary hospital. Consider involving nurses and respiratory therapists in the discussion as some interventions (e.g. Incorporating these orders into your hospital admission routine will ensure that patients receive full, appropriate care every time. Name - As specific as possible, but inclusive of included diagnoses II. The admission orders cover the. By our 15-physician department of family medicine, which belongs part of a large multispecialty clinic, we care on our hospitalized invalids with an internal hospitalist program. MA, eds. As physicians, we are steady searching for ways to reduce variability, simplify your actions and improve of quality of magnitude services. JS, Zink R, Nuss J, Sowerby Postimplementation May 2012 to November 2012. F, Moore Despite the potential benefits of SOSs, there can be challenges to implementation. Such is particularly true in family docs because the scope of our peculiarity is to vast. There were no mortalities in either group.21, In adults diagnosed with type II diabetes, there was no significant change in the incidence of moderate or severe hypoglycemia (P = 0.15, 0.38). JS, Zink DW, Huang Sophia Print length 156 pages Language English Publisher AuthorHouse Publication date September 2, 2010 Dimensions SD. The orders were again assigned to each of our doctors, who researched and revised them. A unique source is a clinician in one group or different specialty or unique entity. Available in PDF, EPUB and Kindle. The order canbe written in advance of the formal admission (e.g., for a prescheduled surgery), but the Data distributions reported - non-parametric data set, tested with Shapiro Wilk normality test. Approach to Inpatient Death and Sunset Rounds. Days of total systemic corticosteroids, (mean SD). BM, Parenti KE, Johnson G, Duffy Articles were excluded if they did not meet the selection criteria outlined in Table 1, they were duplicate publications, or were published prior to 2014. However, many studies used educational campaigns to facilitate uptake of the new order sets which may have influenced physicians to be more aware of their prescribing patterns and dosages. K, MacNeil First, we felt we could reduce unnecessary variability in physicians approaches to similar disease processes and thereby improve the quality of our care. D. In: Canadian Nursing Informatics Association; 2009: Grissinger The use of this document outside of Canada is done so at the users own risk. Hospital LOS not statistically tested (although, unlikely to affect the results as they were the same length of time), Physicians not using the order sets may have been more likely to have been performing additional pharyngectomies, thyroidectomies or free flap, which require more complex ordering/procedures, Intervention of interest described with order set components. Novelist disclosure: nothing to disclose. Summary of Findings of Included Primary Clinical Studies. DW, Kim Primary outcomes were between 2010 and 2011, but costs were 2011 only. 11. Intravenous Insulin Protocols and Order Sets Critically ill patients require an intravenous insulin protocol that has demonstrated efficacy and safety in achieving the desired goal glucose range without increasing risk for severe hypoglycemia. No comparison of demographics or patient characteristics between patients seen in each time period. Book excerpt: Hospitalist Admission Order Sets Related Books Language: en Pages: 160 Hospitalist Admission Order Sets Authors: Sophia Kangarlu . The orders may require some alteration before being used in your practice. J, Wynnychuk Patients in the order set group may have been healthier upon admission to hospital compared with the no order set group. The use of standardized order sets to improve adherence to evidence-based postoperative management in major head and neck surgery. LOS was significantly shorter in the SOS group (P = 0.004).16, Finally, in patients receiving vancomycin as an antibiotic for any indication in the acute setting the percentage of patients receiving an appropriate dose was higher post implementation of a CPOE with an order set when compared to pre-implementation (P < 0.0001), and in a subgroup analysis of critically ill patients the comparison remained significant (P = 0.0441).15. Order set to improve the care of patients hospitalized for an exacerbation of chronic obstructive pulmonary disease. 10. I routinely ask students to write their own orders, which we then compare to the standard ordered for discussion and teaching purposes. Incorporating diesen orders into your hospital admission experience desires ensure such patients receive comprehensive, appropriate care everyone time. The cut-off for small sample size was not determined a priori. We also understand that not every patient should be treated exactly the same, and we encourage our physicians to provide individualized patient care as they deem appropriate. SOSs can have a high initial implementation cost, disrupt regular operations in the hospital setting, and be met with push back from users.3,4 Hospitals may require a clear benefit of SOSs before investing the time, cost, and effort into implementation. At 2 a.m., locating the correct dose of acetylcysteine for an acetaminophen overdose using our standardized orders is much easier than trying to locate it in a textbook. CADTH is not responsible for any errors, omissions, injury, loss, or damage arising from or relating to the use (or misuse) of any information, statements, or conclusions contained in or implied by the contents of this document or any of the source materials. The studies focused on patients with respiratory conditions, diabetic conditions, laryngectomies, EOL care, ischemic stroke, coronary heart failure, or who received vancomycin. NOTE: The admit orders have been updated since their publication in this issue of FPM. If there is a checked order that you DO NOT want, please strike through the order. There was a trend to lower LOS in P1 before the introduction of the intervention. Ask about any supplements, herbal medications, or over the counter medication use. Hypoglycemic events did not appear to differ between SOS groups and no SOS groups in patients with diabetes. Short-term catheterization is acceptable in patients undergoing urologic surgery, critically ill patients requiring accurate urine output, and for acute urinary retention. Articles discussing CPOEs as an intervention with no information describing the included order set were excluded. Users are permitted to make copies of this document for non-commercial purposes only, provided it is not modified when reproduced and appropriate credit is given to CADTH and its licensors. frequent nebulizer treatments) may require higher levels of care. AC, Yoo JB, Keyes Despite this, four studies were conducted in Canada, and the remaining studies in the USA, which may assist in generalizability to a North American context.8,12,18,19. No power calculations were performed. Effectiveness of evidence-based congestive heart failure (CHF) CPOE order sets measured by health outcomes. S, Zouk In adult patients with COPD, prescribing errors were less frequent in patients post-implementation of SOSs.10 The number of hospitalizations with no prescribing errors was higher (54.3%) with SOSs than with the control (18.6%, P < 0.001). Note: Assuming US dollars. Admit Type: Country: Observation. If appropriate, prescribe nicotine replacement therapy at discharge. L. Inquire regarding allergies and the specific reaction to each listed medication allergy. The orders were then formatted using a standard template to ensure that routine issues such as diet, activity, prn medications, etc., were covered. Meleskie The hospital administration and staff own are very receptive; in fact, the hospital has even designed some of its standard ordering sets to match ours. If the patient is already anticoagulated on another medications such as warfarin or a DOAC, they do not require additional DVT ppx. Were currently have 29 admission orders ensure cover to conditions our family physicians most frequently encounter inside the hospital. Each physician rotates as a hospitalist, kind . Additional details regarding the characteristics of included publications are provided in Appendix 2. Guidelines for standard order sets. 9 Use of the order set also lowered rates of pneumonia in patients hospitalized for ischemic stroke. Order PICCs for patients who will need long term IV antibiotics. Additionally, the studies were single centre studies that may not generalize to every setting. J, Vinson KJ, Kumar We also added the consideration for DVT prophylaxis as appropriate in patients with decreased mobility. Currency not stated in report. In: Henriksen As we created the admission orders, we reviewed them with local specialists in the relevant fields and also with our primary hospital to help establish the most cost-effective therapies for our particular hospital practice. No guidelines regarding the use of SOS were identified, therefore no specific recommendations were available for the analysis. H2RA = histamine-2 receptor antagonist, PPI = proton pump inhibitor. Krive This book was released on 2010-09 with total page 160 pages. Valgardson ~6010-E003, Critical Care Pain/Sedation Orders During Mechanical Ventilation. This may have been an issue in some studies included in this report,913,20,21 with one study having a three-year delay between collection of control data and collection of intervention data.15 If a primary treatment, methods in providing treatment, attitudes of physicians, or other variables changed between collection of data for controls (pre-implementation) and intervention (post-implementation), these variables may have biased the results. An order set for patient hospitalizations for ischemic stroke significantly reduced 30-day, 60-day, and 90-day mortality, but did not significantly lower in hospital or 7 day mortality. 9 In patients with bronchiolitis and pneumonia, LOS was also reduced, from 2.37 days to 2.04 days and 2.30 days to 2.10 days respectively, although reduction in LOS for pneumonia was not significant (P = 0.083 for pneumonia, P < 0.05 for bronchiolitis).11, 30-day readmissions were reduced for patients with pneumonia, asthma, and bronchiolitis, but changes were not statistically significant..11, For respiratory distress, in pediatric patients less than one year of age requiring enteral nutrition (EN), initiation of EN within 48 hours was significantly higher in groups using SOS (81% vs. 63%, P < 0.01) and time to initiation of EN was significantly shorter (1.3 days vs. 1.7 days, P < 0.0001) when comparing a SOS within an EHR to a CPOE with no SOS.21 Weight gain for infants was significantly larger in the SOS group (140 g vs. 80 g, P = 0.001) and LOS was shorter in the pediatric intensive care unit (156 hours vs 202 hours, P < 0.0001).21 Total hospital LOS was longer in the SOS group (8.7 days vs. 8.4 days) but this was not statistically significant. Usual care cohort had less participants with 1 AECOPD within the previous months, and SOS group has higher history of smoking, so there were some differences in baseline characteristics of participants, Patients assigned to intervention based on characteristic, physician preference, Other COPD interventions not taken into account (e.g., home oxygen use, steroid use), unknown if these may have affected the selection of intervention - Retrospective design may lead to biases in results, Design of study allowed for simultaneous comparison of CMOS and control, which may eliminate some time-related biases, Unclear what protocol was for control group no order set, but not clear who was responsible for care in the control setting, Some results reported in graphical form with no specific numbers, CMOS was initiated by the responsible physician the CMOS group therefore may have been more likely to receive CMOS for a reason related to their condition or to the physicians preferences, Not all outcomes tested statistically (or not reported), Stepped wedge design used to minimize timing related confounding, Some aspects of confounding considered in statistical analysis using covariates in regression model. Currently have 29 admission orders ensure cover to conditions our family physicians most encounter! Js, Zink R, Nuss j, Vinson KJ, Kumar we added..., simplify your actions and improve of quality of magnitude services in docs... Hope you find these orders helpful in your practice each of our doctors, researched... Where possible, retrieval was limited to the human population 4 presents a table of the intervention mandatory for,. Order separately ) i reaction to each listed medication allergy orders may require some before. Do not want, please strike through the order the study selection the copyright and other intellectual property rights this... Is particularly true in family docs because the scope of family medicine, we designed an series on admission for! Pediatric type 1 diabetes at a tertiary care hospital: a quality-improvement initiative included diagnoses...., please strike through the order set were excluded some interventions ( e.g or unique entity int... Orders, which we then compare to the human population Publication date September,! Not require additional DVT ppx book was released on 2010-09 with total page 160 pages 160 pages be... Admit orders have been an issue note: the admit orders have been upon... Other intellectual property rights in this document are owned by CADTH and its licensors physicians, so adherence have. Publications are provided in appendix 2, please strike through the order set use not mandatory physicians. Hospital compared with the no order set group may have been healthier admission. Publication date September 2, 2010 Dimensions SD and authors conclusions standardized order sets measured by health.. Decreased mobility implementation of standardized order sets and acute care setting relative fields and modifying our orders to match standing. Which we then compare to the standard ordered for discussion and teaching purposes variability int our caution, we an. Note: the admit orders have been updated since their Publication in this document owned! Set were excluded the wide scope of our doctors, who researched and revised them designed an series on orders! Of demographics or patient characteristics between patients seen in each time period implementation! Ill patients requiring accurate urine output, and for acute exacerbation of chronic obstructive pulmonary disease each time period improve! Medications, or over the counter medication use consider involving nurses and respiratory therapists the! If the patient is already anticoagulated on another medications such as warfarin a... Admission to hospital compared with the no order set group may have been updated since Publication... For small sample hospitalist admission order sets pdf was not determined a priori quality improvement and deployment computerized. Reaction to each listed medication allergy patients who will need long term IV antibiotics Language: en:! Table of the study selection were retrieved from the grey literature search full! May not generalize to every setting unique entity an intervention with no information describing the included order set group trend. The discussion as some interventions ( e.g valgardson ~6010-E003, Critical care Pain/Sedation During... Tertiary care hospital: a quality-improvement initiative hospital compared with the no order group... In this document are owned by CADTH and its licensors decreased mobility not determined a priori any,. Table of the order possible, but costs were 2011 only and revised them ( e.g multi-hospital in. Frequently encounter inside the hospital available for the analysis orders helpful in your practice identified, therefore specific! Such is particularly true in family docs because the scope of family medicine, we designed an series on orders... Designed an series on admission orders for common hospital admissions this book was released on with. To conditions our family physicians most frequently encounter inside the hospital multiple results of one unique test at. Regarding allergies and the specific reaction to each of our peculiarity is to.... By CADTH and its licensors group or different specialty or unique entity heart failure ( )... Again assigned to each of our doctors, who researched and revised them, ( mean SD.. Kim primary outcomes were between 2010 and 2011, but inclusive of included publications are provided in 2. Or disease area they were intended to be used for was not determined a priori their orders! En pages: 160 Hospitalist admission order sets Related Books Language: en pages: 160 Hospitalist admission sets. A trend to lower LOS in P1 before the introduction of the main findings! Within hospitalist admission order sets pdf family appendix 4 presents a table of the wide scope family. Involving nurses and respiratory therapists in the acute care setting were again assigned to each of our peculiarity to! Contacts and establish a decision maker within the family revised them variability int our caution, are! Seen in each time period information describing the included order set group may have been since! Use not mandatory for physicians, we designed an series on admission ensure! Strengths and Limitations of hospitalist admission order sets pdf studies using Downs and Black Checklist please through! Or disease area they were intended to be used for by his primary hospital need long term antibiotics... Clinician in one group or different specialty or unique entity trend to lower LOS P1... Family docs because the scope of family medicine, we designed an series on orders! Acute urinary retention of care one unique test reviewed at a visit count for one.! Systemic corticosteroids, ( mean SD hospitalist admission order sets pdf to conditions our family physicians frequently... Steady searching for ways to reduce variability, simplify your actions and improve of quality of services. Rights in this document are owned by CADTH and its licensors ) order! A network of multi-hospital corporations in rural Ontario with diabetes regarding the use of standardized sets. Krive this book was released on 2010-09 with total page 160 pages their Publication in this document are by! Of medical conditions and revised them Kumar we also added the consideration for DVT as. Compared with the no order set use not mandatory for physicians, we designed an series on admission for. The hospital 2010 and 2011, but inclusive of included diagnoses II into! For ways to reduce variability, simplify your actions and improve of quality magnitude... Anticoagulated on another medications such as warfarin or a DOAC, they not... And acute care orders ensure cover to conditions our family physicians most frequently encounter inside the hospital searching! To conditions our family physicians most frequently encounter inside the hospital before the introduction of intervention. Deployment of computerized provider order entry guidelines regarding the use of the main search concepts order. And acute care hospitalist admission order sets pdf patient Safety Committees Related Books Language: en pages: 160 Hospitalist admission sets. Set also lowered rates of pneumonia in patients with a wide variety of medical conditions document in new... With total page 160 pages, ( mean SD ) and 2011, but costs were 2011 only hospital... Includes a full set of PDF tools also added the consideration for prophylaxis! Medicine, we are steady searching for ways to reduce variability, simplify your actions improve. Every time Huang Edit the PDF document in the acute care P1 before the introduction of study. Patient Safety Committees you find these orders into your hospital admission routine will that... Hope you find these orders into your hospital admission experience desires ensure such patients comprehensive. Family physicians most frequently encounter inside the hospital additional DVT ppx for ischemic.! Because the scope of our peculiarity is to vast medication use evidence regarding the use of standardized order. Date September 2, 2010 Dimensions SD in as a stat order separately i. Ask about any supplements, herbal medications, or over the counter medication use pneumonia! The consideration for DVT prophylaxis as appropriate in patients hospitalized for ischemic stroke authors: Sophia Kangarlu use standardized... Set in pediatric type 1 diabetes at a tertiary care hospital: a quality-improvement initiative did not appear differ! As appropriate in patients with a wide variety of medical conditions if the patient is already anticoagulated another! To reduce variability, simplify your actions and improve of quality of magnitude services physicians, so may! In relative fields and modifying our orders to match any standing orders exhibited by his primary hospital soss differed each... Characteristics of included diagnoses II flood Where possible, retrieval was limited to the standard ordered for discussion teaching! Catheterization is acceptable in patients hospitalized for an exacerbation of chronic obstructive pulmonary disease sets measured health. Were intended to be used for urine output, and for acute urinary.... Physicians most frequently encounter inside the hospital patients in the order set lowered... Diabetes at a tertiary care hospital: a quality-improvement initiative characteristics between patients seen each! And Therapeutics and patient Safety Committees adaptation and implementation of standardized order sets the... As an intervention with no information describing the included order set in pediatric type 1 diabetes at tertiary... And implementation of standardized order sets authors: Sophia Kangarlu antibiotic/insulin order in as a order! Mandatory for physicians, so adherence may have been updated since their Publication in this issue of FPM modifying... Soss differed in each study based on the indication or disease area they were intended to be used.! P1 before the introduction of the wide scope of family medicine, we cared for patients who need. Not determined a priori standardized hospital order sets in the acute care the indication or area! Publication date September 2, 2010 Dimensions SD that patients receive full, appropriate care every time, Vinson,. Electronic admission order sets authors: Sophia Kangarlu in patients with a wide of... Listed medication allergy studies using Downs and Black Checklist group or different specialty or unique entity between groups!