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Order Sets (order + set)

Distribution by Scientific Domains
Medical Sciences94%

Selected Abstracts

Use of a Standardized Order Set for Achieving Target Temperature in the Implementation of Therapeutic Hypothermia after Cardiac Arrest: A Feasibility Study

ACADEMIC EMERGENCY MEDICINE, Issue 6 2008
J. Hope Kilgannon MD
Abstract Objectives:, Induced hypothermia (HT) after cardiac arrest improved outcomes in randomized trials. Current post,cardiac arrest treatment guidelines advocate HT; however, utilization in practice remains low. One reported barrier to adoption is clinician concern over potential technical difficulty of HT. We hypothesized that using a standardized order set, clinicians could achieve HT target temperature in routine practice with equal or better efficiency than that observed in randomized trials. Methods:, After a multidisciplinary HT education program, we implemented a standardized order set for HT induction and maintenance including sedation and paralysis, intravenous cold saline infusion, and an external cooling apparatus, with a target temperature range of 33,34°C. We performed a retrospective analysis of a prospectively compiled and maintained registry of cardiac arrest patients with HT attempted (intent-to-treat) over the first year of implementation. The primary outcome measures were defined a priori by extrapolating treatment arm data from the largest and most efficacious randomized trial: 1) successful achievement of target temperature for ,85% of patients in the cohort and 2) median time from return of spontaneous circulation (ROSC) to achieving target temperature <8 hours. Results:, Clinicians attempted HT on 23 post,cardiac arrest patients (arrest location: 78% out-of-hospital, 22% in-hospital; initial rhythm: 26% ventricular fibrillation/tachycardia, 70% pulseless electrical activity or asystole) and achieved the target temperature in 22/23 (96%) cases. Median time from ROSC to target temperature was 4.4 (interquartile range 2.8,7.2) hours. Complication rates were low. Conclusions:, Using a standardized order set, clinicians can achieve HT target temperature in routine practice. [source]

Impact of Human Factor Design on the Use of Order Sets in the Treatment of Congestive Heart Failure

ACADEMIC EMERGENCY MEDICINE, Issue 11 2007
Stewart Reingold MD
Background Although standardized physician order sets are often part of quality improvement projects, the specific design elements contributing to increased adoption and compliance with use often are not considered. Objectives To evaluate the impact of human factor design elements on congestive heart failure (CHF) order set utilization, and compliance with recommended CHF clinical practice guidelines (CPG). Methods This was a descriptive retrospective medical record review of adult patients who were admitted from our emergency department with the primary diagnosis of CHF. We collected data on acuity and CPG parameters before and after the introduction of a new CHF order set. The new orders were succinct and visually well organized, with narrative information to encourage use of CPG. Results Eighty-seven patients were studied before, and 84 after, the introduction of new orders. There were no differences in the use of the order sets based on patient acuity before or after the intervention. Order set use significantly increased by the first postintervention interval (POST) and reached 72% (95% confidence interval [CI] = 52% to 86%) during the third POST, compared with a baseline utilization of 9% (95% CI = 5% to 17%; p < 0.001). Compliance with CPG for angiotensin-converting enzyme reached significance in the second POST and was maintained in the third at 83% (95% CI = 61% to 94%), compared with a baseline value of 25% (95% CI = 7% to 59%; p = 0.008). Intravenous nitroglycerin also increased significantly from the first POST and reached 78% (95% CI = 55% to 91%) in the third POST, compared with baseline of 12% (95% CI = 2% to 47%; p < 0.003). Furosemide dosing, systolic blood pressure reduction, and urine output did not significantly change. Conclusions Introduction of an order set for CHF with attention to human factor design elements significantly improved utilization of the orders and compliance with CPG. [source]

Improving processes of care in patient-controlled analgesia: the impact of computerized order sets and acute pain service patient management

PEDIATRIC ANESTHESIA, Issue 11 2007
CPNP, SHARON WRONA RN
Summary Background:, In an effort to combat opioid induced side effects within the first 24 h of patient-controlled analgesia (PCA) induction, it has been recommended that care be provided by an Acute Pain Treatment Service (APS) and that computerized PCA order sets with patient monitoring requirements be implemented. To date, there are few published studies on the role of computerized order sets or APS in improving the quality and safety of pediatric PCA use. This retrospective analysis sought to determine if the implementation of computerized order sets would increase appropriate monitoring and problem recognition. Methods:, Analysis included 536 patients prescribed PCA in one of three ways: an anesthesia order set with APS support (n = 285), a general PCA order set (n = 95), or no order set (n = 156). We analyzed the use of order sets by unit; the incidence of appropriate monitoring (,12 recordings within 24 h) of respiratory rate, oxygen saturation, and sedation level and the recognition of low respiration rate and low oxygen saturation between the types of PCA order. Results:, We found a significant difference in type of PCA order used by unit. Appropriate documentation of respiratory rate and oxygen saturation occurred significantly more often if the order set with APS was used. Low respiration rate was also recognized significantly more frequently (P , 05) in the APS order set group. Conclusions:, These findings show that use of a computerized PCA order set with monitoring requirements and an APS can increase monitoring and documentation of important vital signs and increase identification of potential negative events. [source]

Use of a Standardized Order Set for Achieving Target Temperature in the Implementation of Therapeutic Hypothermia after Cardiac Arrest: A Feasibility Study

ACADEMIC EMERGENCY MEDICINE, Issue 6 2008
J. Hope Kilgannon MD
Abstract Objectives:, Induced hypothermia (HT) after cardiac arrest improved outcomes in randomized trials. Current post,cardiac arrest treatment guidelines advocate HT; however, utilization in practice remains low. One reported barrier to adoption is clinician concern over potential technical difficulty of HT. We hypothesized that using a standardized order set, clinicians could achieve HT target temperature in routine practice with equal or better efficiency than that observed in randomized trials. Methods:, After a multidisciplinary HT education program, we implemented a standardized order set for HT induction and maintenance including sedation and paralysis, intravenous cold saline infusion, and an external cooling apparatus, with a target temperature range of 33,34°C. We performed a retrospective analysis of a prospectively compiled and maintained registry of cardiac arrest patients with HT attempted (intent-to-treat) over the first year of implementation. The primary outcome measures were defined a priori by extrapolating treatment arm data from the largest and most efficacious randomized trial: 1) successful achievement of target temperature for ,85% of patients in the cohort and 2) median time from return of spontaneous circulation (ROSC) to achieving target temperature <8 hours. Results:, Clinicians attempted HT on 23 post,cardiac arrest patients (arrest location: 78% out-of-hospital, 22% in-hospital; initial rhythm: 26% ventricular fibrillation/tachycardia, 70% pulseless electrical activity or asystole) and achieved the target temperature in 22/23 (96%) cases. Median time from ROSC to target temperature was 4.4 (interquartile range 2.8,7.2) hours. Complication rates were low. Conclusions:, Using a standardized order set, clinicians can achieve HT target temperature in routine practice. [source]

Impact of Human Factor Design on the Use of Order Sets in the Treatment of Congestive Heart Failure

ACADEMIC EMERGENCY MEDICINE, Issue 11 2007
Stewart Reingold MD
Background Although standardized physician order sets are often part of quality improvement projects, the specific design elements contributing to increased adoption and compliance with use often are not considered. Objectives To evaluate the impact of human factor design elements on congestive heart failure (CHF) order set utilization, and compliance with recommended CHF clinical practice guidelines (CPG). Methods This was a descriptive retrospective medical record review of adult patients who were admitted from our emergency department with the primary diagnosis of CHF. We collected data on acuity and CPG parameters before and after the introduction of a new CHF order set. The new orders were succinct and visually well organized, with narrative information to encourage use of CPG. Results Eighty-seven patients were studied before, and 84 after, the introduction of new orders. There were no differences in the use of the order sets based on patient acuity before or after the intervention. Order set use significantly increased by the first postintervention interval (POST) and reached 72% (95% confidence interval [CI] = 52% to 86%) during the third POST, compared with a baseline utilization of 9% (95% CI = 5% to 17%; p < 0.001). Compliance with CPG for angiotensin-converting enzyme reached significance in the second POST and was maintained in the third at 83% (95% CI = 61% to 94%), compared with a baseline value of 25% (95% CI = 7% to 59%; p = 0.008). Intravenous nitroglycerin also increased significantly from the first POST and reached 78% (95% CI = 55% to 91%) in the third POST, compared with baseline of 12% (95% CI = 2% to 47%; p < 0.003). Furosemide dosing, systolic blood pressure reduction, and urine output did not significantly change. Conclusions Introduction of an order set for CHF with attention to human factor design elements significantly improved utilization of the orders and compliance with CPG. [source]

Bon Secours Health System integrates Lean Six Sigma and Knowledge Transfer to drive clinical and operational excellence

GLOBAL BUSINESS AND ORGANIZATIONAL EXCELLENCE, Issue 6 2009
H. Douglas Sears
By harnessing accelerated performance improvement and rapid learning across all of its 29 facilities, Bon Secours pursues consistency, integration, quality, and transparency of patient care, even as it leverages the scale and scope of its operations for higher efficiencies. And now it's pursuing the holy grails of standardized care and a single electronic medical record for each patient. Improvement projects linked to performance gaps in balanced scorecard dashboards are executed with Lean Six Sigma methodologies and rapid-cycle improvement. Communities of Excellence then transfer improvements and replicate proven practices across facilities. This approach is helping fuel two interconnected initiatives: Clinical Transformation, the redesign of workflows,including common order sets and care plans,supported by the new ConnectCare clinical information system, which together aim to standardize 80 percent of patient care across all facilities. © 2009 Wiley Periodicals, Inc. [source]

In response to: Medical admission order sets: Effective, practical, generalizable,but not perfect

JOURNAL OF HOSPITAL MEDICINE, Issue 7 2009
Gregory A. Maynard MD
[source]

Medical admission order sets to improve deep vein thrombosis prevention: A model for others or a prescription for mediocrity?

JOURNAL OF HOSPITAL MEDICINE, Issue 2 2009
Gregory A. Maynard MD
[source]

Improving processes of care in patient-controlled analgesia: the impact of computerized order sets and acute pain service patient management

PEDIATRIC ANESTHESIA, Issue 11 2007
CPNP, SHARON WRONA RN
Summary Background:, In an effort to combat opioid induced side effects within the first 24 h of patient-controlled analgesia (PCA) induction, it has been recommended that care be provided by an Acute Pain Treatment Service (APS) and that computerized PCA order sets with patient monitoring requirements be implemented. To date, there are few published studies on the role of computerized order sets or APS in improving the quality and safety of pediatric PCA use. This retrospective analysis sought to determine if the implementation of computerized order sets would increase appropriate monitoring and problem recognition. Methods:, Analysis included 536 patients prescribed PCA in one of three ways: an anesthesia order set with APS support (n = 285), a general PCA order set (n = 95), or no order set (n = 156). We analyzed the use of order sets by unit; the incidence of appropriate monitoring (,12 recordings within 24 h) of respiratory rate, oxygen saturation, and sedation level and the recognition of low respiration rate and low oxygen saturation between the types of PCA order. Results:, We found a significant difference in type of PCA order used by unit. Appropriate documentation of respiratory rate and oxygen saturation occurred significantly more often if the order set with APS was used. Low respiration rate was also recognized significantly more frequently (P , 05) in the APS order set group. Conclusions:, These findings show that use of a computerized PCA order set with monitoring requirements and an APS can increase monitoring and documentation of important vital signs and increase identification of potential negative events. [source]

Guideline Implementation Research: Exploring the Gap between Evidence and Practice in the CRUSADE Quality Improvement Initiative

ACADEMIC EMERGENCY MEDICINE, Issue 11 2007
Andra L. Blomkalns MD
Translating research results into routine clinical practice remains difficult. Guidelines, such as the 2002 American College of Cardiology/American Heart Association Guidelines for the Management of Patients with Unstable Angina and non-ST-segment elevation myocardial infarction, have been developed to provide a streamlined, evidence-based approach to patient care that is of high quality and is reproducible. The Can Rapid Risk Stratification of Unstable Angina Patients Suppress ADverse Outcomes with Early Implementation (CRUSADE) Quality Improvement Initiative was developed as a registry for non,ST-segment elevation acute coronary syndromes to track the use of guideline-based acute and discharge treatments for hospitalized patients, as well as outcomes associated with the use of these treatments. Care for more than 200,000 patients at more than 400 high-volume acute care hospitals in the United States was tracked in CRUSADE, with feedback provided to participating physicians and hospitals regarding their performance over time and compared with similar institutions. Such access to data has proved important in stimulating improvements in non,ST-segment elevation acute coronary syndromes care at participating hospitals for delivery of acute and discharge guideline-based therapy, as well as improving outcomes for patients. Providing quality improvement methods such as protocol order sets, continuing education programs, and a CRUSADE Quality Improvement Initiative toolbox serve to actively stimulate physician providers and institutions to improve care. The CRUSADE Initiative has also proven to be a fertile source of research in translation of treatment guidelines into routine care, resulting in more than 52 published articles and 86 abstracts presented at major emergency medicine and cardiology meetings. The cycle for research of guideline implementation demonstrated by CRUSADE includes four major steps,observation, intervention, investigation, and publication,that serve as the basis for evaluating the impact of any evidence-based guideline on patient care. Due to the success of CRUSADE, the American College of Cardiology combined the CRUSADE Initiative with the National Registry for Myocardial Infarction ST-segment elevation myocardial infarction program to form the National Cardiovascular Data Registry,Acute Coronary Treatment & Intervention Outcomes Network Registry beginning in January 2007. [source]

Impact of Human Factor Design on the Use of Order Sets in the Treatment of Congestive Heart Failure

ACADEMIC EMERGENCY MEDICINE, Issue 11 2007
Stewart Reingold MD
Background Although standardized physician order sets are often part of quality improvement projects, the specific design elements contributing to increased adoption and compliance with use often are not considered. Objectives To evaluate the impact of human factor design elements on congestive heart failure (CHF) order set utilization, and compliance with recommended CHF clinical practice guidelines (CPG). Methods This was a descriptive retrospective medical record review of adult patients who were admitted from our emergency department with the primary diagnosis of CHF. We collected data on acuity and CPG parameters before and after the introduction of a new CHF order set. The new orders were succinct and visually well organized, with narrative information to encourage use of CPG. Results Eighty-seven patients were studied before, and 84 after, the introduction of new orders. There were no differences in the use of the order sets based on patient acuity before or after the intervention. Order set use significantly increased by the first postintervention interval (POST) and reached 72% (95% confidence interval [CI] = 52% to 86%) during the third POST, compared with a baseline utilization of 9% (95% CI = 5% to 17%; p < 0.001). Compliance with CPG for angiotensin-converting enzyme reached significance in the second POST and was maintained in the third at 83% (95% CI = 61% to 94%), compared with a baseline value of 25% (95% CI = 7% to 59%; p = 0.008). Intravenous nitroglycerin also increased significantly from the first POST and reached 78% (95% CI = 55% to 91%) in the third POST, compared with baseline of 12% (95% CI = 2% to 47%; p < 0.003). Furosemide dosing, systolic blood pressure reduction, and urine output did not significantly change. Conclusions Introduction of an order set for CHF with attention to human factor design elements significantly improved utilization of the orders and compliance with CPG. [source]