Clinical decision support / Health care quality / Uncategorized

Improving healthcare with order sets; a pharmacist’s perspective

April 10, 2017

Guest Post – Neeraj Gupta, Research and Development Pharmacy Intern

There is a saying in hospital pharmacy – we provide care by giving the right medication, at the right dose, to the right patient. Order sets help pharmacists live by this credo. In a hospital environment, patients move through phases of care where they often have diagnostics completed, stop taking old medications and start taking take new drugs. All this health information for a single patient needs to be up to date and shared between different professionals as the patient moves from admission to discharge. When we expand this to all patients in a hospital, this can be a daunting task. How does the pharmacist keep track of all prescription changes while also updating the health status of the patient in real-time?

Raising Awareness

Hospitals use order sets to provide basic guidance and actionable orders for clinicians as the patient moves through phases of care. They act as clinical decision support tools and medical checklists for hospital services like diagnostics and drugs. However, some hospitals have problems with their order sets [1]. Order sets may not contain the most current or best practices for managing a variety of diseases or conditions. Healthcare professionals may not be aware of all the order sets that are available to assist with care. Some hospitals use paper-based order sets that make it difficult to update, track and share information. Not to mention the legibility issues with hand written orders which can be a challenge for pharmacists and can result in errors [2].

Improving Access and Efficiency

A digital order set solution not only streamlines hospital workflows, it also makes the pharmacy more efficient. Switching over to electronic order sets reduces errors due to illegible handwriting and provides better tracking of patient information. Moreover, as best practices change and evolve over time, a digital order set allows for easier updates compared to paper [1]. This could have major implications in reducing preventable harm that occurs in the pharmacy and hospital. It is estimated that 10% of patients in developed countries will be harmed when receiving routine care in hospitals due to medication errors, healthcare associated infections, patient accidents and errors during surgical and medical procedures [3]. This number is significant; 43 million patient safety incidents occur worldwide, with 138,000 incidents occurring annually in Canada [4, 5].

Healthcare professionals like nurses and physicians benefit from digital order sets as they are easily accessible and available at the point-of-care. This can improve a healthcare professional’s workflow and reduce uncertainty when prescribing and treating patients. Clinicians should feel confident that order sets are created with the most recent and best evidence from government, academic literature and practice guidelines.

Delivering better patient outcomes

If we deliver an improved healthcare system using digital order sets, the system would see increases in efficiency and reductions in costs. Approximately 20 to 40% of healthcare spending is wasted due to poor quality care [3]. The additional hospitalization, infections acquired in hospitals, disability, lost productivity and medical expenses can cost some countries as much as $19 billion annually. Order sets help healthcare workers prescribe the most appropriate screening tests and treatments [6], which improves overall patient outcomes [7] while potentially reducing costs and harm. For the hospital pharmacists, who often work in a windowless room, order sets provide a clear view into how they can best help a patient.

Sources used

  1. Bobb AM, Payne TH, Gross PA. Viewpoint: controversies surrounding use of order sets for clinical decision support in computerized provider order entry. J Am Med Inform Assoc 2007;14;41-47.
  2. Devine EB, Hansen RN, Wilson-Norton JL, et al. The impact of computerized provider order entry on medication errors in a multispecialty group practice. J Am Med Inform Assoc 2010;17:78–84. doi:10.1197/jamia.M3285.
  3. World Health Organization. 10 facts on patient safety. Updated June 2014. Accessed March 20, 2017.
  4. Canadian Patient Safety Institute, Canadian Institute for Health information. Measuring patient harm in Canadian hospitals. Published October 2016. Accessed March 21, 2017.
  5. Jha AK, Larizgoitia I, Audera-Lopez C, et al. The global burden of unsafe medical care: analytic modelling of observational studies. BMJ Qual Saf. 2013; 22(10):809-15. doi 10.1136/bmjqs-2012-001748
  6. O’Connor C, Adhikari NKJ, DeCaire K, et al. Medical admission order sets to improve deep vein thrombosis prophylaxis rates and other outcomes. J Hosp Med. 2009; 4(2):81-89. doi 10.1002/jhm.399
  7. Zeidan AM, Streiff MB, Lau BD, et al. Impact of a venous thromboembolism prophylaxis “smart order set”: improved compliance, fewer events. Am J Hematol. 2013; 88(7):545-549.