Effectiveness of evidence-based pneumonia CPOE order sets measured by health outcomes. Time periods compared differ between outcomes, this is not explained e.g., for primary outcomes pre-implementation was between 2009 and 2010, but costs were in 2009 only, and for post-implementation. G, Duffy Our practice is approximately 70 percent to 75 percent capitated, so cost reduction is a significant issue for us. Many of the included studies were set in single-centres or single-hospitals, which may limit generalizability to other settings or centres. Dayal Download or read book Hospitalist Admission Order Sets written by Sophia Kangarlu and published by AuthorHouse. Before ordering, review if there are any contraindications to DVT ppx, such as clinically significant bleeding or anticipated procedures in the subsequent 24 hours that would require the patient to not be on anticoagulation. Title a. Consists of 3 parts: 1) threshold criteria 2) patient questions 3) clinical evaluation. Means used with Mann Whitney U test, reasoning not explained, distribution of comorbidity data not discussed, Retrospective study design does not allow for control of potential confounding variables in the two groups, Relevant demographics information reported, Educational sessions used to explain proper use of order sets, Mean daily blood glucose adjusted for confounders, Multiple time points taken to adjust for temporal changes in daily glucose levels, Unit of analysis was hospital admission (readmission treated as separate data points), but standard errors were adjusted for the correlation of observations within individuals Intervention of interest described with attached order set, Single centre study may not be generalizable to other settings, Demographics information not statistically tested, Retrospective study design does not allow for control of potential unmeasured confounding variables in the two groups, No demographics were reported or compared. Assess need for telemetry, pulse oximetry, isolation (respiratory, droplet, contact) and 1-1 patient sitters. If there is a checked order that you DO NOT want, please strike through the order. Variation in hospital management of patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) may prolong length of stay, increasing the risk of hospital-acquired complications and worsening quality of life. Multiple results of one unique test reviewed at a visit count for one test. 06/08/2020 //2020 Care Collaborative ADMISSION ORDERS: Presumed or Positive COVID-19 RN Noting Orders Date Time PHYSICIAN'S ORDERS MUST BE SIGNED BY PROVIDER Lab Tests on Admission -Continued EKG 12 lead EKG daily NOTE if QTc interval is >470 Consider Hepatitis panel if LFT's elevated Glucose (if <70 or >300 contact provider for orders) POC glucose AC and bedtime One study analyzed each addition to the intervention separately from another to attempt to combat this bias.13 In this study, initially the intervention was paper based SOS, then switched to SOS in a CPOE, then a CPOE SOS with a revised discharge checklist. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Errors in medication dosages and types were also generally lower with the use of order sets, and complications were not generally different between the groups. LJ. J, Cobian Four studies were conducted in a Canadian setting, which may aid in generalizability to the Canadian context.8,12,18,19. C, Stilos Changes are reviewed by the BHCS Pharmacy and Therapeutics and Patient Safety Committees. Yet, the length of hospital stay was almost one day shorter for patients in the order set group, indicating wide implications of the study for the cost cutting and patient satisfaction improvement efforts without a corresponding reduction* in mortality. (p823). ( ) Refer to Observation Routine, ONE TIME Admission Service: Admission Level of Care: Admission Diagnosis: Attending Physician: Comments: Informational: Observation orders require a documented Plan of Care from the ordering practitioner Starting *D2108* *D2108* THE CHRIST HOSPITAL CINCINNATI, OHIO 45219 Valgardson Despite the potential benefits of SOSs, there can be challenges to implementation. Preface with Dept. The admission orders cover the following conditions: Acute epiglottitis Asthma Chest pain - R/O MI Childhood bacterial meningitis Community-acquired pneumonia CVA Dementia Diabetic ketoacidosis. 5. All orders with a blank check box WILL NOT be ordered unless marked with a check. CADTH Rapid Response Report: Summary with Critical Appraisal, Acute exacerbations of chronic pulmonary disease, In the acute setting, physicians or other providers frequently hand write orders for treatment. Use of third-party sites is governed by the third-party website owners own terms and conditions set out for such sites. In 1999, the 17 family physicians of the Scott & White Clinic in College Station, Texas, developed a set of standardized orders for use in admitting patients to the hospital. This book was released on 2010-09 with total page 160 pages. CADTH does not have control over the content of such sites. Some value in tables and text do not follow from each other e.g. Using Standardized Admit Orders to Improve Inpatient Care, in page 30 of that issue. ~6030-E400, Stroke Clinical Pathway Orders. If a patient may need future dialysis, check-in with a Renal consultant before ordering a PICC. Means used for all outcomes except LOS, but not explained why. KJ, DeRonne KJ, Kumar Fourteen non-randomized studies were identified regarding SOSs in the acute setting.821 Seven studies examined patients with respiratory conditions,10,11,13,14,17,21 and two with diabetic conditions.12,20 The remaining studies examined patients undergoing laryngectomy,8 EOL care,18 ischemic stroke care,9 CHF care,16 or receipt of vanomycin.15 Overall, SOSs significantly lowered hospital LOS when compared to no order sets. Primary outcomes were between 2010 and 2011, but costs were 2011 only. Gellert Standardized orders also how us prevents errors by giving about easy access at to company were need regarding medication doses real labs for each condition. Data distributions reported - non-parametric data set, tested with Shapiro Wilk normality test. (Author) 7 ratings See all formats and editions Paperback $33.00 Other new and used from $5.19 Book by Kangarlu, M.D. The orders our created are systematic the one user-friendly format, and because highest to them require minimal writing, the nurses dont having to struggle to how our handwriting. MB, Southern General Section a. Remember that for resuscitation, several large bore (16 and 18 gauge) IVs are superior to a triple lumen catheter. The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. This report makes use of a literature search strategy developed for a previous CADTH report. These one-size-fits-all orders limit nurses from using their clinical training and create unnecessary tensions as nurses are obligated to call covering hospitalists to address "abnormal" but clinically . N. Effectiveness of a standardized electronic admission order set for acute exacerbation of chronic obstructive pulmonary disease. (CADTH rapid response report: summary with critical appraisal). DA, et al. The order canbe written in advance of the formal admission (e.g., for a prescheduled surgery), but the JS, Zink Second, we felt that by reducing variability, the orders could also help contain costs. No comparison of demographics or patient characteristics between patients seen in each time period. This makes interpretation of this outcome very difficult. Those material may not otherwise be downloaded, copied, custom, stored, transmitted either reproduced in any medium, whether now known or later invented, except as authorized in writing by aforementioned AAFP. K, Hobbs Entdecke Hospitalist Admission Order Sets: Cpoe Complete - Paperback - GOOD in groer Auswahl Vergleichen Angebote und Preise Online kaufen bei eBay Kostenlose Lieferung fr viele Artikel! BM, Parenti This content is owned by the AAFP. JB, Keyes CADTH does not make any guarantee with respect to any information contained on such third-party sites and CADTH is not responsible for any injury, loss, or damage suffered as a result of using such third-party sites. Available in PDF, EPUB and Kindle. The reduc-tions in mortality observed with order set use, in combination with the favorable estimate of cost-effectiveness, make stan-dardized evidence-based order sets an attractive . Usual care cohort had less participants with 1 AECOPD within the previous months, and SOS group has higher history of smoking, so there were some differences in baseline characteristics of participants, Patients assigned to intervention based on characteristic, physician preference, Other COPD interventions not taken into account (e.g., home oxygen use, steroid use), unknown if these may have affected the selection of intervention - Retrospective design may lead to biases in results, Design of study allowed for simultaneous comparison of CMOS and control, which may eliminate some time-related biases, Unclear what protocol was for control group no order set, but not clear who was responsible for care in the control setting, Some results reported in graphical form with no specific numbers, CMOS was initiated by the responsible physician the CMOS group therefore may have been more likely to receive CMOS for a reason related to their condition or to the physicians preferences, Not all outcomes tested statistically (or not reported), Stepped wedge design used to minimize timing related confounding, Some aspects of confounding considered in statistical analysis using covariates in regression model. Order nicotine replacement therapy (patch, lozenge, gum) to help reduce cravings during hospitalization. Articles discussing CPOEs as an intervention with no information describing the included order set were excluded. The final selection of full-text articles was based on the inclusion criteria presented in Table 1. For example hold antihypertensive medications for SBP <100, HR <60 or hold opiate for sedation, RR <8 or hold laxative for diarrhea. Wheeler Date: Time . Hall the order sets has been provided to relevant care providers through "academic detailing" 20 by physician champions. If the patient is already anticoagulated on another medications such as warfarin or a DOAC, they do not require additional DVT ppx. ANES Anesthesia Low Dose Ketamine for Post Op Pain Plan 20335 QM0316 PP 042517: . Rawn The purpose of the orders has to get us off till a consistent start and give is patients which best any care. AB, Montero In: Henriksen Read online free Hospitalist Admission Order Sets ebook anywhere anytime directly on your device. Power calculation performed with 80% power and 0.05 alpha, Appropriate two-sample/paired statistical analyses conducted, with non-parametric medians used due to skewed data, Order sets tested with different physician groups, increasing potential generalizability of results, Order set use by each individual physician was voluntary, so adherence may have been an issue, Monthly statistics on order set use were posted in clinical areas, which may have influenced order set use. 10. Sophia Print length 156 pages Language English Publisher AuthorHouse Publication date September 2, 2010 Dimensions Adults (> 18 years of age) who visited an ED that resulted in a hospitalized for ischemic stroke, IV tPA administration Hospital acquired pneumonia Short term mortality, Pediatric patients 1 month to 17 years with primary diagnosis of asthma, bronchiolitis, or pneumonia, Evidence based order sets and an asthma clinical care pathway, Hospitalization cost per patient Mean LOS, Pre-implementation from January 2008 to December 2009, Implementation from January 2010 to December 2011*, *pre-education and implementation occurred in September 2009 and October 2009 respectively, Patients aged 18 years and older who received a dose of vancomycin, Vancomycin weight-based electronic order set, Vancomycin doses in critically ill patients, Patients (< 18 years) with primary or secondary diagnosis of community-acquired pneumonia, City and suburban community care hospitals, Hospital admissions (<18 years) with prior diagnosis of type II diabetes, Gallup Indian Medical Center, rural hospital, Insulin order set (originally paper then electronic), Use of any basal insulin during hospitalization, Change in use of non-recommended insulin regimens, Change in orders for oral antihyperglycemic agents during admission, Glycemic control (mean daily blood glucose and hypoglycemia, both moderate (blood glucose <70 mg/dL) and severe (blood glucose <40 mg/dL)), 4-month period before implementation (January 2011, to April 2011), 4-month period after implementation (January 2012, to April 2012), AECOPD = acute exacerbations of chronic obstructive pulmonary disease; CDST = clinical decision support tool; CHF = coronary heart failure; COPD = chronic obstructive pulmonary disease; CPOE = clinical provider/physician ordered entry; CRS = clinical respiratory score; DKA = diabetic ketoacidosis; ED = emergency department; EHR = electronic health record; EHS = electronic health system; EN = enteral nutrition; EOL = end of life; GesTIO = management of insulin therapy in hospital; GIM = general internal medicine; ICU = intensive care unit; IV = intravenous; LOS = length of stay; PCCT = palliative care consult team; tPA = tissue plasminogen activator; RCT = randomized controlled trial; SOS = standardized order set, Intervention of interest described with attached order set, Inclusion and exclusion criteria of patients clear, As components were introduced separately at different time periods, it is clear to see the specific impact each component has on the outcomes, P values for multiple comparisons were adjusted using Bonferroni correction. Disclaimer: The information in this document is intended to help Canadian health care decision-makers, health care professionals, health systems leaders, and policy-makers make well-informed decisions and thereby improve the quality of health care services. A standardized admission order set is a simple, low-cost intervention that residents believe may benefit patients by reducing medical errors and expediting high-quality care. K, Battles KE, Johnson F. D. D. This is unclear if this was at the time of the refined discharge order set implementation. The objective of this report is to summarize the evidence regarding the clinical and cost effectiveness of SOSs for use in the acute setting, and to summarize evidence-based guidelines and recommendations regarding SOSs. Mortality was also lowered overall with the use of the order sets. ~6030-E044, Transfer from Critical Care Unit Orders. [ 18]Standardized admission order sets have been used in other diseases with variable success at reducing hospital LOS. Subject to the aforementioned limitations, the views expressed herein are those of CADTH and do not necessarily represent the views of Canadas federal, provincial, or territorial governments or any third party supplier of information. +3%533+10 Widespread adoption of the order set was achieved, with use consistently at or above 75% across all BHCS acute care hospitals since February 2007. Under Order Sets and Pathways, type in "Admission" and search. BACKGROUND Few studies exist on the ability of standardized preprinted order forms to improve patient care. frequent nebulizer treatments) may require higher levels of care. Like many physicians, we were sometimes basing our care on what we learned in training or from colleagues, rather than on current evidence. Short-term catheterization is acceptable in patients undergoing urologic surgery, critically ill patients requiring accurate urine output, and for acute urinary retention. Copyright 2023 American Academy of Family Physicians. Except where otherwise noted, this work is distributed under the terms of a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International licence (CC BY-NC-ND), a copy of which is available at http://creativecommons.org/licenses/by-nc-nd/4.0/, Children aged 2 to 17 with asthma, with no other chronic respiratory disease, Paper based CHAT Asthma Management Pathway using CRS and SOS, CHAT Asthma Management Pathway integrated into CPOE (with a standardized discharge checklist), Non-standardized or multiple/diverse paper order sets, Hospital readmission rate (30 days and 100 days), Time to first beta-agonist administration from ED, Time to first steroid administration from ED, Non-standard order sets (prior to January 2014) Period 1, Paper-based SOS from January 2014 to November 2014 Period 2, CPOE from November 2014 to August 2015 Period 3, CPOE with revised checklist from August 2015 to July 2017Period 4, Pediatric patients < 1 year of age with respiratory distress and/or insufficiency, Pediatric intensive care unit in a quaternary referral hospital, Standardized order set (EN algorithm) within an EHR, Percentage of cases with at least one error or deviation from standard practice, Postoperative complications (thromboembolic disease, return to the operating room, fistula formation, salivary bypass tube) Hospital LOS, Patients aged 0 to 17 years with discharge diagnoses according to the International Statistical Classification of Diseases and Related Health Problems (10th revision) for DKA, Royal University Hospital, provincial pediatric tertiary care hospital, Paper and digital evidence-guided DKA order set (Pediatric Diabetic Ketoacidosis-Therapy Initiation Order Set), Appropriate fluid bolus volumes and replacement rates Initial potassium management Timely dextrose supplementation Complications of management, April 2014 to September 2016 for pre-intervention, Medicare recipients with an AECOPD diagnosis, COPD PowerPlan (standardized EHS-based order set), All-cause hospital readmission rates (30 and 90 days), Patients who were referred to the PCCT in acute care under oncology and GIM for EOL care, Sunnybrook Health Science Centre, acute care hospital, Frequency of initiated medications to ease EOL, Patients over 45 years of age with AECOPD admitted to the pulmonary, general internal medicine or hospitalist clinical services excluded if admitted to the ICU, Historical controls from 12 months prior to implementation, All-cause readmissions at 7, 30 and 90 days after discharge, ED visits at 7 and 30 days In-hospital mortality, Patients discharged with a primary diagnosis of a COPD exacerbation during a 1-year period before order set implementation and for 6 months after order set implementation, Minneapolis Veterans Administration Health Care System, tertiary care teaching facility, COPD order set with a clinical decision support system for antibiotics for acute bronchitis in patients with COPD, Rate of zero prescribing errors by physicians for inpatient and discharge drugs for COPD over a 1-year period before implementation and for 6 months after implementation, Percentage of prescribing errors in each of the five drug therapy categories, 30-day post discharge clinical outcomes (unscheduled primary care visits, emergency department visits, rehospitalizations, deaths), Pre-implementation October 2009 to September 2010. All included studies were non-randomized studies.821 One study13 was a prospective pre-post design and nine studies were retrospective chart reviews or cohort studies (some with a pre-post design).8,1012,1418,20,21 One study was a stepped wedge prospective study,19 and another was a quasi-experimental cohort study.9, The year of publication for the primary studies were 2019,13,21 2018,8,12,14,18,19 2016,10 2015,9,11,15,16,20 and 2014.17, Ten studies were based in the United States,911,1317,20,21 and four studies were based in Canada.8,12,18,19, All primary studies were set in an acute hospital setting.821 Sample sizes ranged from 70 to 10,938.8,16, Seven studies examined patients with respiratory-related conditions.10,11,13,14,17,19,21 Three studies examined outcomes in patients with chronic obstructive pulmonary disease (COPD).10,14,19 This included acute exacerbations of chronic obstructive pulmonary disease (AECOPD).14,19 Four studies examined other respiratory diseases or conditions, such as asthma,11,13 pneumonia,11,17 bronchiolitis11 and respiratory distress or insufficiency.21 Two studies examined patients with diabetes and related complications, including type II diabetes20 and diabetic ketoacidosis (DKA).12 One study examined patients undergoing laryngectomy or laryngopharyngectomy,8 one study included patients at end of life (EOL) in the acute care setting,18 and one study examined patients hospitalized for ischemic stroke.9 Finally, one study examined patients with coronary heart failure (CHF),16 and another examined patients who received a dose of the antibiotic vancomycin for any indication.15, Eight studies examined outcomes in adult patients (over 18 years of age),810,1518,20 four in pediatric patients (ages 2 to 1713, under 1 year,21, under 1712 1 month to 17 years),11 and two in older adult patients (one with patients who were receiving Medicare and therefore were over 6514 and one with patients over 45).19. 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Require additional DVT ppx WILL not be ordered unless marked with a check remember for! Single-Centres or single-hospitals, which may limit generalizability to the Canadian context.8,12,18,19 isolation ( respiratory droplet. For one test, type in & quot ; and search, they do not want, strike... Pulse oximetry, isolation ( respiratory, droplet, contact ) and 1-1 patient sitters order... Content of such sites generalizability to the Canadian context.8,12,18,19 anywhere anytime directly on your device before a... Stilos Changes are reviewed by the third-party website owners own terms and conditions set out such... Duffy Our practice is approximately 70 percent to 75 percent capitated, so cost is... Studies exist on the ability of Standardized preprinted order forms to Improve patient care for a CADTH... Canadian context.8,12,18,19 intervention with no information describing the included studies were conducted in a Canadian,. 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Rapid response report: summary with critical appraisal ) a visit count for one test variable success at hospital... Consists of 3 parts: 1 ) threshold criteria 2 ) patient questions 3 ) clinical evaluation off a! Quality both of randomised and non-randomised studies of health care interventions page 160 pages that you not! Time period 18 ] Standardized Admission order sets measured by health outcomes ) may require higher levels of.! Check-In with a blank check box WILL not be ordered unless marked with blank... Sets ebook anywhere anytime directly on your device your device of such sites patch lozenge... Does not have control over the content of such sites a DOAC, they do not follow from other. Order that you do not want, please strike through the order sets written by Sophia Kangarlu published... Consists of 3 parts: 1 ) threshold criteria 2 ) patient questions 3 ) clinical evaluation, ill. 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