What are the evidence-based guidelines regarding the use of standardized hospital order sets in the acute care setting? ME, Kim Inquire regarding allergies and the specific reaction to each listed medication allergy. ~6010-E003, Critical Care Pain/Sedation Orders During Mechanical Ventilation. This is to support decision making with regards to the implementation of SOSs in the acute setting, such as in tertiary, community, and regional hospitals, and across multiple jurisdictions. Fourteen non-randomized studies were identified regarding SOSs in the acute setting.821 Seven studies examined patients with respiratory conditions,10,11,13,14,17,21 and two with diabetic conditions.12,20 The remaining studies examined patients undergoing laryngectomy,8 EOL care,18 ischemic stroke care,9 CHF care,16 or receipt of vanomycin.15 Overall, SOSs significantly lowered hospital LOS when compared to no order sets. K, Battles The reduc-tions in mortality observed with order set use, in combination with the favorable estimate of cost-effectiveness, make stan-dardized evidence-based order sets an attractive . C, Inman This document may contain links to third-party websites. KJ, Kumar Copyright 2023 American Academy of Family Physicians. Standardized order sets reduce medication errors and create efficiency for physicians, nurses, and pharmacists.1 A less recognized benefit may be that standardized orders promote equity in care and may help to mitigate disparities that occur along racial and ethnic lines. 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. The effect of implementation of standardized, evidence-based order sets on efficiency and quality measures for pediatric respiratory illnesses in a community hospital. Except where otherwise noted, this work is distributed under the terms of a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International licence (CC BY-NC-ND), a copy of which is available at http://creativecommons.org/licenses/by-nc-nd/4.0/, Children aged 2 to 17 with asthma, with no other chronic respiratory disease, Paper based CHAT Asthma Management Pathway using CRS and SOS, CHAT Asthma Management Pathway integrated into CPOE (with a standardized discharge checklist), Non-standardized or multiple/diverse paper order sets, Hospital readmission rate (30 days and 100 days), Time to first beta-agonist administration from ED, Time to first steroid administration from ED, Non-standard order sets (prior to January 2014) Period 1, Paper-based SOS from January 2014 to November 2014 Period 2, CPOE from November 2014 to August 2015 Period 3, CPOE with revised checklist from August 2015 to July 2017Period 4, Pediatric patients < 1 year of age with respiratory distress and/or insufficiency, Pediatric intensive care unit in a quaternary referral hospital, Standardized order set (EN algorithm) within an EHR, Percentage of cases with at least one error or deviation from standard practice, Postoperative complications (thromboembolic disease, return to the operating room, fistula formation, salivary bypass tube) Hospital LOS, Patients aged 0 to 17 years with discharge diagnoses according to the International Statistical Classification of Diseases and Related Health Problems (10th revision) for DKA, Royal University Hospital, provincial pediatric tertiary care hospital, Paper and digital evidence-guided DKA order set (Pediatric Diabetic Ketoacidosis-Therapy Initiation Order Set), Appropriate fluid bolus volumes and replacement rates Initial potassium management Timely dextrose supplementation Complications of management, April 2014 to September 2016 for pre-intervention, Medicare recipients with an AECOPD diagnosis, COPD PowerPlan (standardized EHS-based order set), All-cause hospital readmission rates (30 and 90 days), Patients who were referred to the PCCT in acute care under oncology and GIM for EOL care, Sunnybrook Health Science Centre, acute care hospital, Frequency of initiated medications to ease EOL, Patients over 45 years of age with AECOPD admitted to the pulmonary, general internal medicine or hospitalist clinical services excluded if admitted to the ICU, Historical controls from 12 months prior to implementation, All-cause readmissions at 7, 30 and 90 days after discharge, ED visits at 7 and 30 days In-hospital mortality, Patients discharged with a primary diagnosis of a COPD exacerbation during a 1-year period before order set implementation and for 6 months after order set implementation, Minneapolis Veterans Administration Health Care System, tertiary care teaching facility, COPD order set with a clinical decision support system for antibiotics for acute bronchitis in patients with COPD, Rate of zero prescribing errors by physicians for inpatient and discharge drugs for COPD over a 1-year period before implementation and for 6 months after implementation, Percentage of prescribing errors in each of the five drug therapy categories, 30-day post discharge clinical outcomes (unscheduled primary care visits, emergency department visits, rehospitalizations, deaths), Pre-implementation October 2009 to September 2010. 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. Hospitalist Admission Order Sets: CPOE Complete. Appendix 4 presents a table of the main study findings and authors conclusions. Rawn J, Regan Available in PDF, EPUB and Kindle. We also added the consideration for DVT prophylaxis as appropriate in patients with decreased mobility. Ballard Incorporating these orders into your hospital admission routine will ensure that patients receiver comprehensive, appropriate care every set. One study analyzed each addition to the intervention separately from another to attempt to combat this bias.13 In this study, initially the intervention was paper based SOS, then switched to SOS in a CPOE, then a CPOE SOS with a revised discharge checklist. 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. CADTH has no responsibility for the collection, use, and disclosure of personal information by third-party sites. NOTE: The admit orders have been updated since their publication in this issue of FPM. This report expands on a previous CADTH report, Standardized Hospital Order Sets in Acute Care: Clinical Evidence, Cost-Effectiveness, and Guidelines, published in 2019.5. Eventually, all of our physicians began to share this responsibility one week at a time, which left each of our doctors having a fairly intensive inpatient experience every three to four months. J, et al. M. You will be downloading the most current version. All orders with a blank check box WILL NOT be ordered unless marked with a check. C, Stilos If additional documentation is needed for the hospital admission, click Notes from the Activity Menu. Copyright 2023 American Academy of Family Clinical. This comes checking certain orders with specialists in relative fields and modifying our orders to match any standing orders exhibited by his primary hospital. Multiple results of one unique test reviewed at a visit count for one test. In: 2009: Standardized hospital order sets in acute care: clinical evidence, cost-effectiveness, and guidelines. A total of 480 citations were identified in the literature search. The orders our created are systematic the one user-friendly format, and because highest to them require minimal writing, the nurses dont having to struggle to how our handwriting. This content is owned by the AAFP. All studies were clear with respect to the aims or objectives of the study.821 Additionally, mostly due to the designs of the studies, no loss to follow up was reported.821 Many studies were clear on their interventions, either explaining the components of the order sets or attaching the order set in a figure or appendix.8,10,1222 One study did not have an attached order set or discuss the specific components of the sets.11, Studies with a pre-post design (a design in which the intervention does not occur simultaneously or in a relatively close time period to the control) are at risk from time-related confounding. Implementation of computerized physician order entry is associated with increased thrombolytic administration for emergency department patients with acute ischemic stroke. Many of these patients problems were relatively routine, while others were less common or more complex and, therefore, more difficult for our admitting physicians to manage. Edit the PDF document in the new dashboard which includes a full set of PDF tools. DR, Reed In 1999, the 17 family physicians of the Scott & White Clinic in College Station, Texas, developed a set of standardized orders for use in admitting patients to the hospital. This study represents a preliminary review of several areas that the CMOS may address in promoting more comprehensive EOL care, particularly around assessment of symptoms and management of existential distress. (p659), This study reveals that with use of the CMOS, there was a statistically significant increase in the number of referrals to spiritual care for assistance with psychosocial and spiritual suffering along a patients continuum of disease (p658), No significant differences between groups for comorbidities, Admitting speciality, (%), SOS vs. control, Patients with co-existing heart failure and diabetes were more commonly admitted under general internists. Page 3, Order set use increased gradually post-implementation, Overall difference (adjusted): 0.39 (95% CI 0.94, 0.15), P = 0.156, Overall difference (unadjusted): 0.36 (95% CI 0.87, 0.15), P = 0.164, Unadjusted difference of 1.15 fewer days (95% CI 0.50, 1.81, P = 0.001), favouring SOS group, Adjusted difference of 0.73 fewer days (95% CI 1.40, 0.07, P = 0.031), favouring SOS group, In hospitalist group, unadjusted difference of 1.78 days (95% CI 0.95, 2.61), favouring SOS group, No significant difference in respirologist or general internists group, for either unadjusted (95% CI 2.67, 4.47 and 1.66, 2.02 respectively) or adjusted (95% CI 1.18, 4.22 and 1.39, 2.56 respectively), Adjusted OR (post vs. pre-implementation): 1.16 (95% CI 0.87, 1.55), Adjusted OR (SOS vs. no SOS**): 1.17 (95% CI 0.87, 1.59), Adjusted OR (post vs. pre-implementation): 1.03 (95% CI 0.8, 1.34), Adjusted OR (SOS vs. no SOS**): 1.07 (95% CI 0.82, 1.41), **SOS vs. no SOS was a comparison of the use of SOS by attending physicians, Note: admissions are the unit of measurement in this study, COPD hospitalizations with zero physician prescribing errors, (%), Physician prescribing errors per hospitalization, number (mean), Physician prescribing errors, (%), SOS vs. control, Systemic corticosteroid prescribing: 28% vs. 58%, P < 0.001, Short-acting bronchodilator: 2.5% vs. 13.9% (P = 0.005), Discharge without prescription for long-acting bronchodilator, (%), Discharge without prescription for inhaled corticosteroid, (%), Adverse clinical outcomes, %, no SOS vs. SOS, Rates of unscheduled physician visits: 2.1% vs. 2.5%, P = 0.84, Emergency department visits: 15.5% vs. 12.3%, P = 0.48, Rehospitalizations: 23.2% vs. 21%, P = 0.65, Documented mNIHSS unknown, SOS vs. no SOS, %, Documentation of dysphagia, SOS vs. no SOS, %, IV tPA in ED, rate difference with order set, % (95% CI), Pneumonia, rate difference with order set, % (95% CI), In-hospital mortality, rate difference with order set, % (95% CI), 7-day, mortality rate difference with order set, % (95% CI), 30-day mortality, rate difference with order set, % (95% CI), 60-day mortality, rate difference with order set, % (95% CI), 90day mortality, rate difference with order set, % (95% CI), In our supplemental analysis, we observed a lower risk of inpatient pneumonia and a mortality benefit at 30 to 90 days post-admission amongst patients in which the CPOE ED stroke order set was used. Page 9, In summary, during a staggered implementation of a CPOE-EHR across medical centers within a large integrated health system, the availability of a CPOE-EHR with an ED stroke order set and specific use of this order set was associated with increased use of IV tPA. (p10), Pre-implementation (no SOS, primary outcomes) n = 870, Post implementation (SOS, primary outcomes) n = 688, Pre-implementation (pharmacy inventory data) n = 457, Post implementation (pharmacy inventory data) n = 439, Asthma + Bronchiolitis + Pneumonia (overall), days, Asthma + Bronchiolitis + Pneumonia (overall), %, Average number of medications per patient, SOS vs.no SOS, Mean total hospital utilization cost per patient with asthma, Post-implementation (January 2011December 2011): $1174. Certain orders with a blank check box will NOT be ordered unless with! A check Pain/Sedation orders During Mechanical Ventilation prophylaxis as appropriate in patients with decreased mobility me Kim. 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