Any order with a check mark will be ordered. ~6010-D005, Critical Care Orders. AB, Montero H2RA = histamine-2 receptor antagonist, PPI = proton pump inhibitor. Where possible, retrieval was limited to the human population. The cut-off for small sample size was not determined a priori. Hospital LOS not statistically tested (although, unlikely to affect the results as they were the same length of time), Physicians not using the order sets may have been more likely to have been performing additional pharyngectomies, thyroidectomies or free flap, which require more complex ordering/procedures, Intervention of interest described with order set components. Hospitalist Admission Order Sets. Padua prediction score risk assessment model: a total score of 4 indicates a high risk of venous thromboembolism (VTE) and should receive DVT prophylaxis. Sutter Roseville. No filters were applied to limit the retrieval by study type. ~6010-E162, Therapeutic Hypothermia After Cardiac Arrest. (Author) 7 ratings See all formats and editions Paperback $33.00 Other new and used from $5.19 Book by Kangarlu, M.D. Order set use was up to physicians discretion may have been influenced by other factors such as severity of disease or physician preference. 12. These comprised 14 non-randomized studies. No relevant guidelines regarding SOSs was identified; therefore, no summary can be provided. 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. They were edited by the clinics division director. 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. A, Wilson See permissionsforcopyrightquestions and/or permission requests. Reviews aren't verified, but Google checks for and removes fake content when it's identified . If a patient may need future dialysis, check-in with a Renal consultant before ordering a PICC. KJ, DeRonne 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. BM, Parenti Available in PDF, EPUB and Kindle. Like many physicians, we were sometimes basing our care on what we learned in training or from colleagues, rather than on current evidence. Changes in protocol mid-intervention e.g., originally physicians nurse and respiratory therapist responsible for ensuring use of discharge checklist but switched to discharge nurse due to inadequate completion. Dayal If patients have renal impairment (CrCl <30 mL/min) or are at the extremes of body weight (BMI <20 kg/m2 or >35 kg/m2) dose adjustments may be required, especially for low molecular weight heparins. Results written in a misleading way e.g., The binary logistic regression method revealed that 1.8% of patients in the order set group died versus 3.2% in the free text group (p821) This seems like the number of deaths in each group came from a regression model, when in actuality they came from ICD-9 codes in the patient files. As costs can change over time in hospitals and per year, data was omitted that could have affected the results, Pharmacy utilization data only available between 2008 and 2010, Relevant demographic information reported, Subgroup analyses performed on indications and weight groups, Intervention of interest described with components, Protocol pre-CPOE is unclear. Order sets: quality improvement now while building a foundation for CPOE success. The orders may require some alteration before being used in your practice. Reducing pediatric asthma hospital length of stay through evidence-based quality improvement and deployment of computerized provider order entry. Each order set is reviewed and updated annually by subspecialty teams, physician champions, and the Physician Design Team. Gellert Brown For example, in the treatment of UGI bleeding, many of our physicians were using IV H2-blockers for initial management, although oral medications were as effective yet less costly in patients not actively vomiting. Effectiveness of inpatient insulin order sets using human insulins in noncritically ill patients in a rural hospital. The use of this document outside of Canada is done so at the users own risk. Book excerpt: Hospitalist Admission Order Sets Related Books Language: en Pages: 160 Hospitalist Admission Order Sets Authors: Sophia Kangarlu All-cause hospital readmission, (%), SOS vs. control, Type of service, disease, time of consult until death, number of days all non-significantly different between groups, Involvement of spiritual care significantly different between groups, CMOS vs. control (%), Patient comfort status (%) CMOS vs. Control, Most frequent symptom contributing to discomfort in both groups was dyspnea, greater in the control group (P = NR), 87% of the time actions were completed if a patient was not comfortable, regardless of group, Overall, the CMOS is a useful strategy in improving processes in EOL care in an inpatient setting, though not fully sufficient. During our most recent round the updates, we added new orders to stasis heart failure and pancreatitis (see "Admit orders") and made minor edit to pre-existing orders. A, Alvarez AECOPD = acute exacerbation chronic obstructive pulmonary disease; CCI = clinical comorbidities index; CDST = clinical decision support tool; CMOS = comfort measures order set; CPOE = computerized provider order entry; ICD-9 = International Classification of Diseases, Ninth Revision; FEV1 = forced expiratory volume; LOS = length of stay; PICU = pediatric intensive care unit; SOS = standardized order set, N = 1494 visits total, 1223 unique patients, Period 3 (P3) - CPOE + SOS + discharge checklist, Period 4 (P4) - CPOE + SOS + revised checklist, CPOE month over month use rate was 83 to 89% (mean of 85%), Discharge checklist use rate increase 18% to 72%, LOS (geometric mean, hours), general linear model. Unknown if selection bias present in the groups. Therefore, the order sets evaluated in this report may not generalize to other indications, and order sets specifically made for other indications may not have the same results as ones included in this report. Multiple results of one unique test reviewed at a visit count for one test. Adaptation and implementation of standardized order sets in a network of multi-hospital corporations in rural Ontario. Hall The admission orders cover the following conditions: Copyright 2001 by the American Academy of Family Physicians. J, Cobian Our reasons for developing the standardized admission orders were threefold. Appendix 4 presents a table of the main study findings and authors conclusions. The main search concepts were order sets and acute care. As we created the admission orders, we reviewed them with local specialists in the relevant fields and also with our primary hospital to help establish the most cost-effective therapies for our particular hospital practice. The comfort measures order set at a tertiary care academic hospital: is there a comparable difference in end-of-life care between patients dying in acute care when CMOS is utilized? Hospital length of stay was also shorter (2.9 days vs. 4 days, P = 0.002), and the difference in rates of adverse events (unscheduled physician visits, emergency department visits, rehospitalizations, and deaths) were not statistically different.10, In older adults (65 and older) with AECOPD, for implementation of SOSs compared with pre-implementation of SOSs (all patients included), median hospital LOS was 3 days with the SOS and 4 days with no order set (P = 0.02).14 The SOS was independently associated with LOS (beta = 0.92, P = 0.006) after adjustment for age, sex, race, and smoking status. DG, Tetzlaff We sought to determine whether an evidence-based computerized AECOPD admission order set could improve quality and reduce length of stay. In April of this year, we revisited our standard orders to upgrade and update them. Confounding not considered nor adjusted for, Patient demographics reported and tested statistically between groups, Multivariate analysis used to test for association of factors that differed between groups to choose to use the SOS, and found to be not be significant, Multiple regression model used, and confounders adjusted for, No losses to follow-up due to study design, Some values differ between text and tables e.g., mean age of whole cohort transcribed as 62 in text and 69 in table, FEV1 score differ (55.1% vs. 53%). 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. Nursing Special c. *Vital Signs d. Notify Physician e. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. JAMA Intern Med 2015; 175:512. ~6010-E001, Shock & Severe Sepsis ICU Order Set. Although no evidence on cost-effectiveness was identified, in one study, hospitalization costs associated with the SOS (US$1174) for pneumonia, bronchiolitis, and asthma were lower in comparison to no SOS (US$2010), but this was not statistically tested.11. This disclaimer and any questions or matters of any nature arising from or relating to the content or use (or misuse) of this document will be governed by and interpreted in accordance with the laws of the Province of Ontario and the laws of Canada applicable therein, and all proceedings shall be subject to the exclusive jurisdiction of the courts of the Province of Ontario, Canada. CG, Castano Approach to Inpatient Death and Sunset Rounds. Inquire regarding allergies and the specific reaction to each listed medication allergy. BACKGROUND Few studies exist on the ability of standardized preprinted order forms to improve patient care. This makes interpretation of this outcome very difficult. LJ. The orders were again assigned to each of our doctors, who researched and revised them. [The clinics orders were originally published in the November/December 1999 issue of FPM. A total of 480 citations were identified in the literature search. Unknown if appropriate non-parametric test used for this outcome (other tests done using t-tests, not clear for LOS). 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. ~6010-E003, Critical Care Pain/Sedation Orders During Mechanical Ventilation. JI, Hudson In another pre-post study of older adults (over 45 years) with AECOPD, there was no difference in median hospital LOS between pre- and post-implementation.19 A subset analysis in which only included patients that had the order set used in their care compared to patients that did not have an order set used found a significant difference in LOS, favouring the order sets (adjusted median difference in days 0.73, 95% CI 1.40, 0.07). 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 This overlap of dates is not explained. This document may contain links to third-party websites. Promoting best practice and safety through preprinted physician orders. The effect of implementation of standardized, evidence-based order sets on efficiency and quality measures for pediatric respiratory illnesses in a community hospital. Unclear if order sets were used non-electronic sets in hospital, Demographic information not tested statistically, Three-year delay between data for pre-CPOE and post-CPOE may lead to time-related confounding, if practice had changed within that time period, No conflicts of interest statement reported, Appropriate logistic regression modeling used for binary outcomes, No time related confounding as both intervention and comparator occurred in the same time period, No demographics were reported or compared - Adherence of order set was low, Uses the acronym CF for what is assumed to be confidence interval but does not define it, this is unclear, Chi square test used originally (no significance found) and fishers exact test used afterwards (due to small sample sizes) to find significance. 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. Additional details regarding the characteristics of included publications are provided in Appendix 2. We also understand that not every patient should be treated exactly the same, and we encourage our physicians to provide individualized patient care as they deem appropriate. Additionally, power calculations were performed for two of the included studies,10,19 but not all studies had a power calculation, so it is unknown whether all studies had appropriate power to detect a statistical difference. Uses the acronym CF for what is assumed to be confidence interval but does not define it. Confounders were adjusted for or included in the data analysis of three studies.14,19,20 Five studies did not include a statistical analysis of demographic information,9,10,13,15,20 or report demographics,11 so the extent of imbalance of confounders in the initial populations is unknown. 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. Each physician rotates as a hospitalist, kind entirely for family medicine inpatients for one week every very months. SH, Black J, Hudson A person viewing it online maybe make one printout of the material and maybe used that printout only for his or her personal, non-commercial reference. A hospitalist admission order sets pdf the main study findings and authors conclusions improve quality and reduce length of through... Order entry American Academy of Family physicians determine whether an evidence-based computerized AECOPD admission order.... 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