Clinical order sets are one tool in the clinician’s toolbox for ensuring patient safety and reducing risk. What exactly is a Clinical Order set you ask? It is a pre-defined template that provides support in making clinical decisions for a specific condition or medical procedure. Simply put, it guides a clinician while treating a patient to ensure that they do not miss any critical components of care. For many years, hospitals have utilized clinical order sets, and in the past, they have been created and stored on paper. However, in today’s healthcare environment, it is increasingly important that they are maintained electronically. It’s time to ditch the paper and embrace technology.
Research has shown that the implementation of electronic clinical order sets improves compliance with recommended standards of care and ultimately improves patient outcomes. Multiple studies have found a reduction in the overall length of hospital stay, a reduction in postoperative length of stay, and a reduction in total charges for various surgical procedures, including total knee arthroplasty, appendectomy, and colon surgery. It’s proved to be quite a nifty tool in that toolbox.
Electronic Clinical Order Sets Success Story in Dallas
A recent study at Baylor Health Care System, a multi-hospital system in Dallas, TX with more than 100,000 admissions annually, showed a 33-34% reduction in in-hospital mortality after implementation of an electronic pneumonia clinical order set. Clinician compliance with relevant procedures also increased, and patients for whom the order set was used were 22 to 24 percent more likely to receive all the pneumonia Joint Commission Core Measures for which they were eligible.
Effective clinical order sets are developed by a multi-disciplinary team of clinical experts, using the most current medical evidence. In a large multi-site hospital where busy clinicians must come together in a central location, this process can be very difficult. In an age where time is already of the essence, extreme thought and care must be considered. Once order sets are established, they must be regularly reviewed and updated, which can be a similarly arduous process. However, if there is a mismatch between a current document and a past version of a document, then it could lead to significant patient safety errors. Version control may seem like a pesky issue but when it’s a matter of life and death it must be held in the highest regard. Thankfully there are various systems that have been designed to aid in this process.
In addition to keeping clinical order sets up to date, handwritten orders prove to be a challenge in the successful implementation of clinical order sets. In the past, clinicians have hand-written or verbally communicated orders for patient care to other individuals for transcription. In a fast-paced hospital environment, handwritten orders are prone to poor legibility and non-standard abbreviations, leading to potential errors in patient care. For example, a 2006 report by the Institute of Medicine estimated that a hospitalized patient is exposed to a medication error each day of his or her stay. That number is far too high for anyone’s liking.
An effective electronic clinical order sets system has several qualities and can circumvent these challenges:
- Evidence-based – Clinical order sets should reflect the best practices and the latest research in relevant fields.
- Cloud-based and portable – Cloud-based clinical order sets allow health care organizations to have a highly accessible system without extensive IT demands. Clinicians can utilize the system from any location through any device, including mobile devices and tablets. Updates are immediately reflected throughout the system.
- Streamlined creation and review process – An easy to use, intuitive interface combined with robust online collaboration tools increase clinician participation and buy-in and ensure order sets are kept up to date.
- Patient safety checks – A clinical order set system should confirm patient identification, drug dose recommendations, adverse drug reaction, and checks on allergies.
- Regulatory compliance and security– Access to an electronic clinical order system is secure and aligned with regulatory requirements, specifically HIPAA. Electronic signatures verify identities of clinicians.
- Reporting and analytics – Relevant data entered into electronic clinical order set systems should be captured and made available for analysis. This will track systematic trends and give valuable insight into patient care.
- Sufficient training and support – There must be sufficient training and support employed at all levels to ensure successful implementation.
Increasing the use of electronic clinical order sets is important in all clinical settings: acute care hospitals, long-term care homes, continuing care organizations, and other areas of the health care spectrum. They ensure patient safety by helping clinicians complete each intervention safely and in a standardized manner. In addition to mitigating risk, implementation of electronic clinical order sets is an important step in compliance with the Center for Medicare and Medicaid Services meaningful use and Joint Commission Core Measures.
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