Systems Structures Presentation (PPP)
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Clinical orders for specific diagnosis
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Systems Structures Presentation (PPP)
- 1. System Structures Presentation: Clinical Orders for Specific Diagnosis Team A Maureen Alfonso Alison Cayson Debbie Fernando Pam Gordon Visal Srey HCS/533 May 27, 2013 Jacqueline Sommerville
- 2. An Introduction: Standard Clinical Orders O Benefits O Save time and money O Decrease medication errors O Simplify admission process O Obtain data O Concerns O Rush patient care O Ignore the individual
- 3. Impact on Health Care Delivery O Reduce time to place common orders O Ensure quality of care O Reduce medical errors O Provide consistent evidence-based standards O Comply with Core Measures O Improve quality of patient outcomes O Reduce length of stay
- 4. Training Involved O Physicians O Check allergies and contraindications O Mark wanted orders and cross out unwanted orders O Nurses O Carry out orders O Double check allergies and contraindications O Ancillary Staff O Understand the orders O Know the routine O All Staff know and follow HIPAA regulations
- 5. Impact on Future Evolutions O Able to update for changes in best practice O Multiple order sets available for secondary diagnoses O Lower cost of care delivery O Reduce adverse events and errors O More disease specific as new diseases are found O Ability to add to or delete as needed
- 6. Maintenance ComponentsO Specific coded IDs for patients O Coded bracelets O Numerical ID codes O Provider Access O Encrypted password O Must be changed periodically O Timely deletion of patient information O Research and Statistics O Patient information removed O Other information to staff as necessary O System updates as necessary
- 7. Implication of Privacy and Security Management OLimited number of order sets OAttention to alerts OUser-specific access to order sets OPassword protected OStaff to sign off when not using OPrivacy screens for computer monitors
- 8. Data Collection Usage O Illnesses commonly found in area O Illnesses commonly treated O Communicable diseases O Consider new vaccines O Track STDs O Follow ups O Types of medication prescribed O Number of different medications prescribed O Unnecessary usage of hospital emergency services
- 9. Steps in System Development Life Cycle O Project Definition O User Requirements O System Requirements O Analysis and Design O System Build O Prototype O Training O Implementation O Maintenance and Upgrades
- 10. Evaluation of Structure Effectiveness O Interdisciplinary collaboration O Decrease deviations in patient care O Develop and implement best evidence-based operational and clinical models O Provide clinical decision support at point of care O Improve quality of care O Decrease patient errors
- 11. Hardware Issues to be Considered O Number of Computers O Stationary O Laptops O Network O Printers O Number O Functions O Locations O Miscellaneous
- 12. Sample Order Sheet for Medications for Asthma
- 13. Sample Physician Order Sheet for Aftercare of addiction
- 14. In Conclusion O Impact of standard clinical orders to be determined by users O Time savings and convenience O Quality care and the human factor vs.
- 15. References O Balci, O. (2012, July). A life cycle for modeling and simulation. Simulation 88(7), 870-883. O Caliendo, M. (2013). Rutgers ranks urban hospitals on usage. NJBIZ, 26(14), 2-3. Retrieved from http://search.proquest.com/docview/1350300444?accountid=35812 O Chisolm, D., McAlearney, A., Veneris, S., Fisher, D., Holtzlander, M., & McCoy, K. (2006). The role of computerized order sets in pediatric inpatient asthma treatment. Pediatric Allergy and Immunology, 17(3), 199-206. O Feldman, L. (2010). Hospitals advised to be thorough when deploying clinical decision support tools. Hospitals & Health Networks, 84(5), 16-16. Retrieved from: http://search.proquest.com/docview/338487299?accountid=35812
- 16. References O Munasinghe, R., Camelia, A., Abraham, T., Zida, M., & Siddique, M. (2011, May- June). Improving the utilization of admission order sets in a computerized physician order entry system by integrating modular disease specific order subsets into a general medicine admission order set. Journal of the American Informatics Association, 13 (3), 322-326. O Matiti, M., & Trorey, G. (2008). Patients' expectations of the maintenance of their dignity. Journal of Clinical Nursing, 17(20), 2709-2717. doi:10.1111/j.1365- 2702.2008.02365.x O SVPOD 032 Rosary Hall Order Set Physician orders Aftercare Orders. (2013). Retrieved from http://orders4printsv.com/svpod032rosaryhallordersetphysicianordersafterc areorders.aspx O Welcome to HIPAA 101. (2012). Retrieved from http://www.hipaa-101.com/
Editor's Notes
- This power point presentation is an examination of standard clinical orders for specific admission diagnosis. These standard order sets are being used by an increasing number of health care organizations because they provide many benefits. Their use represents best practices because admitting physicians save time and money, medication errors are decreased, and the admission process is simplified. Also, facilities find it easier to gather data for analysis once admitting physicians adopt standard order sets. With the data obtained, it is possible to determine which illnesses are common, which medications are prescribed, and what hospital services are being used. This information allows physicians to devise more effective treatments and hospital administrators to develop more efficient operating strategies. Though, standard clinical orders for specific admission diagnosis have many benefits, health care providers should remember that these standard orders can and should be modified, if necessary. Tests or procedures need to be added or crossed out after evaluating a patient's health history and individual needs; quality care should never be sacrificed for convenience.
- Order sets can reduce the time needed to enter orders. Physicians frequently order the same tests, procedures, and medications for specific diagnoses. Quality of care is improved by inclusion of orders necessary for patient safety. Medical errors and omissions can be reduced as order sets have been pre-approved for specific disease processes. According to "HC Pro" (2013), “These orders have been carefully developed by a team of physicians who consult medical literature for evidence-based standards.” Orders required to meet core measures are included. This is especially important for patients with multiple diagnoses. Studies have demonstrated that such admission order sets improve immunization rates and appropriate antibiotic use, as well as reduce the length of hospital stays (Munasinghe, 2011).
- Physicians need to be trained to use pre-printed orders. They need to be reminded to check a patient’s allergies or other contraindications against the pre-written orders. Instructions to make a check mark next to the orders that apply to a particular patient and mark through the ones that do not apply should also be included. Nurses need to be trained on how to read and sign off on the orders. They need to know that only the orders with check marks are to be carried out. The ones marked through are to be ignored. The nurses should also be instructed to re-check patient allergies and contraindications. Even if the physician has checked these, the nurse needs to check them too. The ancillary staff also needs to know what the checked and marked through orders mean. They need to make certain the nurse has signed off on the orders before they are carried out. For example, if a x-ray of the left leg is ordered, the x-ray tech needs to make sure the nurse has signed off on the order before she does the x-ray. This will be another way to confirm that the correct leg is being x-rayed. If the physician ordered an x-ray of the left leg, and the nurse verified that it is the left leg and signed off on the orders, then the x-ray tech can perform the x-ray. The training of the system offers an ideal time to reinforce all staff to the HIPAA rules and regulations. They should be able to name the main 5 rules: Security Rule, Privacy Rule, Identifiers Rule, Transaction Rule, and Enforcement Rule.
- Order sets can be revised to reflect updates in best practices and to incorporate additions to core measures and required documentation. Patients with co-morbidities may require additional orders specific for that diagnosis. Appropriate treatment from the time of admission can reduce length of stay, prevent un-necessary procedures, and lower the cost of delivering care. Some systems can trigger alerts for conflicting orders, duplication of orders, or incompatible medications and allergies. This can assist in the reduction of adverse events and medical errors. It can also cut down on the amount of time the staff wastes with duplicate orders. Much time is wasted when the nurse finds and order that is a repeat and then has to go back and make sure the first one was carried out. As new diseases are uncovered, specific orders can be added for this disease. Based on best practice evidence based, orders and medications can be added to or deleted from the orders.
- Many large health care facilities are using ID bracelets to ensure the privacy and security of patient data. Specific codes are found on the bracelet along with the patient’s first and last names and date of birth (Matiti & Trorey, 2008). These bracelets are completely coded with a scan bar or encoded with an alphanumeric barcode. Health care providers also need a password to access a patient’s health records (Matiti & Trorey, 2008). Finally, patient information is timed for automatic deletion once the patient has been discharged from the hospital. As a result, any data being used for research and statistical purposes will require private information such as name, birth date, social security number, home address, and phone number to be deleted (Matiti & Trorey, 2008).
- Specific order sets should be limited to specific diagnoses. Customized sets for individual physicians can overload the system and reduce efficiency. Physicians must pay close attention to alerts triggered to prevent adverse events. All access should be limited to appropriate personnel. Individual user access and password protection with alerts for inappropriate access will ensure compliance with HIPAA and other local, state and federal regulations. Each computer will be equipped with a privacy screen so that by-passers cannot view any information
- Specific information gathered from patients admitted to a facility will be used to develop more effective treatments for future patients and reduce operating costs for the facility. The information will figure out the illnesses commonly found within the community, as well as their prevalence (Caliendo, 2013). This data will track the types of medications commonly used or needed so the facility can order appropriately (Caliendo, 2013). When patients present with a communicable disease, it is important for the facility to diagnosis that as soon as possible and be able to relay that information to other facilities is the area to be able to track and treat the disease. If a common disease is frequent, consideration of developing a vaccine may be considered. Sexually transmitted diseases also need tracking. It has been found recently, that the older generation are transmitting STDs, probably related to the common use of erectile dysfunction medications. Finally, the collected data will indicate if patients are utilizing hospital emergency services for true emergencies, or if an urgent care center for non-emergency services is needed (Caliendo, 2013).
- The steps in the system development life cycle are planning, analysis, design and implementation, and includes evaluating the organization's objectives. System analysis defines project goals and end-user information needs. System design details the features and operations desired by the organization. The development phase is where the computer program is written, integrated and implemented. Training has to be provided and continuously evaluated for effectiveness. Maintenance and upgrades are the changes, corrections and additions made necessary by technological advances and the evolving needs of the organization (Balci, 2012).
- Integrating order subsets for the most common medical diagnoses into a general medical admission order set can be evaluated by analyzing the utilization patterns of health care providers. During a 16-month study, results showed the total number of order sets used by clinicians in all departments increased fivefold in the implementation phase of the pilot. Integration of disease specific order subsets into a single general admission order set significantly improved the overall adoption of order sets by clinicians (Munasinge etal, 2011). Disease specific order sets ensure that orders meet performance measures, use evidence- based best practices, and provide clinical decision support to health care providers. These incorporated system structures support interdisciplinary collaboration and reduce adverse events and medical errors.
- Hardware is also an important consideration when converting to pre-printed orders. The steering committee needs to decide whether there will be a computer for every nurse. Will every physician have his own? Will two nurses share a computer? How many will be “hooked to a table” and how many will be portable? Possible locations for the major printer will need to be considered. Will the physician print out his orders when the patient arrives or will the nurse have several copies already printed out and placed in a folder? The most effective method would be for each physician to have a folder containing several copies of his group’s orders that is stored in an accessible location. The appointed person could then pull the orders from the folder and place them in the chart for the physician. The Network will have to be chosen and named. Other necessary decisions are who will make certain there is paper in the printer, who will be responsible for ordering ink cartridges, and who will make copies. Before purchasing a printer, it is important to decide whether it will also scan, collate, print both sides, etc.. Printer speed needs to be considered too. Other hardware must be purchased. Each computer will need a mouse (wired or wireless) and computer stands, holders or carts, paper holders and other small attachments will also be required.
- Fig. 1. Sample screen shot for asthma order set. This screen shot of a segment of the asthma order set shows the standard format used for all order sets. Clinicians using order entry may check as many options as they deem necessary. Selected orders are pre-checked to ensure that clinicians consider these orders for all patients. Clinicians, however, maintain the option to uncheck pre-checked items.
- Sample of a physician order set for aftercare of on opioid addiction patient. These are manufactured by a company and are for sale on the internet.
- Standard clinical orders for specific admission diagnosis provide many benefits to patients, physicians, and hospitals, but there are concerns. Some clinicians worry that the use of standard order sets will cause providers to rush through the patient consultation and ignore rare and unusual symptoms. The impact of standard clinical orders on health care will be determined by the providers who use them. Most health care providers want to deliver high-quality care. They realize that these standard order sets are only part of testing and treating patients; it is still necessary to take a medical history, evaluate the patient, and acknowledge the individual. The human factor still needs to be part of the health care equation.