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Best Practices for Implementing Order Sets Cheat Sheet (DRAFT) by [deleted]

Best Practices for Implementing Order Sets

This is a draft cheat sheet. It is a work in progress and is not finished yet.

Introd­uction

Determ­ining and standa­rdizing order sets through physician consensus and then implem­enting their use can be a daunting task for organi­zat­ions. Hospitals can improve their success at implem­enting these sets through six best practices.

1. Order sets address organi­zat­ional goals

Hospitals should begin their order-set implem­ent­ation efforts by focusing first on developing order sets that directly address organi­zat­ional goals, says Dr. Peitzman. For example, if a hospital has a goal of a core measures score of 95 percent, a starting point may be creating order sets related to any measure that falls below 95 percent.

Starting with order sets that directly affect organi­zat­ional goals helps the process better gain hospital leadership and physician support and is more likely to bring about signif­icant change in an organi­zation

2. Determine the process for creating order sets

Next, organi­zations need to determine the process they will use to reach consensus on these order sets. Key clinical leaders, such as department chairs and other physic­ians, should be directly involved in the develo­pment process for order sets relevant to their specialty

3. Begin with a starting point.

Begin with existing order sets and adapt them to fit their needs.

"A starting point could be an order set already used in the organi­zation or another source, such as another organi­zation or a software product of eviden­ce-­based order sets," says Dr. Peitzman. "­These starting sets should also include links or references to the underlying evidence used to develop the sets. This evidence will help physicians come to consen­sus."

Order Set Develo­pment

 

4. Decide how order sets will be implem­ented.

After determ­ining a process for developing the sets, organi­zations should decide how they will implement them. Organi­zations should consider whether or not they will make use of the sets voluntary or mandatory and if they will use paper or electronic implem­ent­ation with comput­erized physician order entry.

"If organi­zations are focused on achieving meaningful use, they will need to show a certain percent of order sets are being done in the CPOE system­," says Dr. Peitzman.

If an organi­zation chooses to enter the order sets into the CPOE system, it should set goals of how many sets it will enter by a certain time frame and develop a process for entering the sets, says Dr. Peitzman. Some tools for order set management allow order sets to be integrated automa­tic­ally, but if organi­zations manually maintain order sets in other ways, such as in an Excel spread­sheet, they need to assign resources to this process.

5. Allocate resources to maintain data sets

Organi­zations must also allocate resources to maintain order sets and ensure they are up-to-­date.

"­Med­ication guidelines change all the time as new studies show a new drug or dose would be better, or other research suggests other best practices for treatm­ent­s," says Dr. Peitzman.

While some electronic order set management tools will update users of new guidel­ines, it is still important that organi­zations have an assigned point person to monitor the new inform­ation and incorp­orate it into order sets. Organi­zations without such tools typically rely on department chairs to stay abreast of the latest research and place them in charge of updating order sets accord­ingly.

If an organi­zation chooses to use an order set management tool, Dr. Peitzman recommends it consider the quality of evidence sources, integr­ation capability to CPOE systems and the ease of mainte­nance when selecting a specific program.

6. Monitor perfor­mance.

Finally, organi­zations should routinely monitor the impact of the order sets on organi­zat­ional goals. For example, did implem­enting an order set improve core measures? If an organi­zation finds that movement toward organi­zat­ional goals is lacking, it needs to have resources in place to invest­igate why this is occurring and what changes can be made to improve the positive impact of the order sets.
"If in six months, an organi­zation hasn’t experi­enced improv­ements, organi­zations need to try to understand why," says Dr. Peitzman. "­Org­ani­zations should monitor utiliz­ation and if it is lacking, find a way to make order sets more user friend­ly."­
                       

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