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Order Sets Initiative

FAQs: Standardization of Order Sets - Adult Facilities

The following FAQs are applicable to the adult facilities. Standardization of order sets is being done in selected areas at Kosair Children's Hospital and is being coordinated at the facility level.

Can I send my routine order sets from the office with my patient when they are admitted?

Yes, at this time. As a standardized order set is developed for the specific procedure/condition, we hope that you would choose to use the standard order set.

Will physician-specific order sets be built in CareLINK?

No. Norton Healthcare plans to establish Standardized physician order sets developed through consensus and evidence based medicine. Our goal is to evaluate all current physician order sets and establish condition specific order sets.   It will be vital for physicians to involve themselves in the process of approval and evaluation of order sets.

Will physician-specific order sets be stored within the portal or other electronic mechanism, or on the nursing units?

The physician specific order sets that are currently in Meditech at Audubon and Suburban will be available electronically through the portal. Our goal is to eventually replace physician specific order sets with standardized, evidence based order sets that will meet your needs.

What are the advantages of standardized order sets?

  • Standardization of the processes of care contributes to achievement of quality and patient safety goals
  • Standardized order sets will be developed using the Zynx evidence based tool, thus creating sets that are based on the latest clinical literature. This assists you in keeping up with best practices (changes) and applying them in the care of your patients.
  • Standardization and housing the order sets electronically allows for version control, so that you always have the current version at your fingertips.
  • Standardization now will make the transition to computerized provider order entry (CPOE) within the next several years much easier.

What happened to the order sets that were in Meditech at Audubon and Suburban?

If those order sets are already standardized and medical staff approved, they will be built in CareLINK.   As an interim solution, hospital approved and physician specific order sets that are currently in Meditech at Audubon or Suburban will be housed on the portal for your use. As that order set is standardized for the system, it will be replaced. The remaining order sets will be maintained on the portal for your use until they are standardized. We will work to evaluate the common elements of these order sets and develop standardized ones from them.

How will I know what order sets are available in CareLINK?

In CareLINK order entry, pull down menus will show what order sets are available. If the order set is standardized, it will be followed by "NHC".

Where will I find those order sets?    

In Carelink order sets are accessed through the MD Orders icon.

If I use a standardized order set, do I have to select all items in the order set?

No. By definition, an order set allows you to individually select each item. So it is your option to not select a specific item.

Can I add additional handwritten orders to a standardized order set?

There will be space on some of the order sets; if additional space is needed a regular blank order sheet can be used.  

What is the difference between an order set, standing order and protocol.?

An order set is a list of individually selectable interventions that the ordering practitioner may choose from. A standing order is an order (orders) that may be initiated without an order by the nurse if the patient meets certain criteria. Those criteria and the resulting orders require prior approval in policy by the medical staff. A protocol also requires the patient to meet certain clinical criteria, but there must be an   order to initiate the protocol.

What are the "priority" order sets?   How were the "priority" order sets for standardization chosen?

The following order sets have been identified as priority for initial standardization:

  • Acute MI
  • CHF
  • Pneumonia (Community Acquired)
  • Term Pregnancy
  • Percutaneous Coronary Intervention (PCI)
  • CABG
  • Other Open Chest Cardiac surgery
  • Ventilator weaning
  • Total Knee Replacement
  • Total Hip Replacement
  • Hip Fracture
  • DVT Prophylaxis
  • Glycemic control
  • Perioperative Antibiotics

 

  • Colectomy
  • Stroke
  • Influenza/Pneumococcal Immunizations
  • Total Hysterectomy (Abdominal and Vaginal)
  • Abdominal Aortic Aneurysm Repair
  • Cervical Laminectomy (with/without fusion)
  • Lumbar Laminectomy (with/without fusion)
  • Craniotomy
  • COPD
  • Asthma - Pediatric
  • Pneumonia (Community Acquired) - Pediatric
  • Sepsis
  • Bariatric Surgery
  • TPN
  • Heparin Protocols

 

These were chosen based on several factors; the volume of patients affected by the order sets, the impact of the order set on improving publicly reported quality data, protecting patient safety and the availability of Zynx to assist in the development.

What is Zynx?

Zynx is an evidence based medicine tool that allows creation of order sets.   This tool will enable Norton Healthcare to develop literature based order sets that will eventually provide real time clinical decision support.  This tool is a web based application that all physicians will be able to utilize for literature search and review.  The tool can be accessed by www.zynx.com.

What will be the mechanism for updating order sets as clinical practice changes, or making changes to order sets.?

There are several ways that that can happen. Through use of the Zynx tool, we are notified of any changes in current practice, recalls of medications, etc. Through the searching capabilities of the tool, we can identify specifically which order sets are affected. In addition, through the standardization initiative, we will maintain a central data base of all order sets so that they can be searched against, and modified as needed.

Changes to an order set will be requested through a change request process already in place through Clinical Informatics. To request a change, contact the Clinical Informatics Manager at your hospital.

Norton Hospital : Peggy Serrano - 502-629-1896

Norton Audubon Hospital : Joy Karrer - 502-636-7220

Norton Suburban Hospital : Liz Bennie - 502-899-6974

Norton Kosair Hospital: Janice White - 502-629-4667

Who will oversee this process?

There has been a steering committee established that will oversee the process. This committee consists of Dr. Ken Wilson, AVP Clinical Affairs, Deve Vetter, AVP Accreditation/MS Credentials. Alice Keeling, VP Quality, Ben Yandell, Division Director Clinical Information Analysis, and Judy Bradley, Division Director Clinical Informatics. One of this committee's roles is to be sure that the appropriate medical staff and other discipline involvement are obtained in the development, review and revision of order sets.

Who can I talk to for input or questions?

Dr. Steve Hester - 502-629-3176  Steve.Hester@Nortonhealthcare.org

Dr. Ken Wilson - 502-629-5578 Kenneth.Wilson@Nortonhealthcare.org 

Deve Vetter - 502-629-5596 Deve.Vetter@Nortonhealthcare.org

Dee Jones, RN  - 502-629-2166 Dee.Jones@Nortonhealthcare.org

 

 

10-3-05

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