Clinical decision support

Pediatric Order Set Updates: Perspectives from the Field, Part One

April 2, 2018

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At Think Research, we’re committed to working with clinical leaders in our network, and we were fortunate to recently sit down with Dr. Catherine Taylor, leading Pediatrician from Trillium Health Partners, in order to gather feedback on our Pediatric Order Set updates.

Can you tell me about why and how you became interested in Order Sets for your department?

There are many reasons why Order Sets were important, but for my team, the biggest driver was to standardize the care that patients receive. For us, it was even more important that the standardization is evidence-based, so that we can be confident we are truly providing the best possible care.

What challenges have you had during the development process of the Order Sets? Are there any barriers in accessing the documents?

For us, there aren’t really any barriers to accessing documents, but the challenge really is in keeping up with the latest evidence. It takes time to develop an Order Set, and sometimes there’s a delay in updating that Order Set with the newest evidence, so staying up-to-date is a challenge for us all.

Are all of the clinicians in your department using the Order Sets? Could you summarize other MD feedback?

Order Sets have been in use at our hospital site for quite some time (some might call us early adopters!) We experienced some delays in developing Order Sets across all of our sites, after the merger 5 years back, and there are still some access-related adoption barriers that we are currently working through. But we recognize that harmonizing things across all sites can take some time.

When it comes to accessing documents in EntryPoint, what works? Are there any challenges or barriers?

With EntryPoint, it’s very easy to find what you’re looking for. The integration with Meditech (our EHR system) allows us to pull up a patient’s record, and from there, instantly navigate to EntryPoint. The search feature is also very intuitive, but as with any new software, individuals just need to get comfortable with using it. One feature that would be ideal would be the flexibility to modify an ‘orderline’, so hopefully that feature can be built into future iterations.

How have Pediatric Order Sets helped your facility?

They’ve helped us in 2 ways. The first is that they’ve helped to standardize care and communication, so nurses are better able to follow orders because they’re legible, clear and less prone to error. The second is that clinicians are now less likely to miss an important order because everything is laid out in front of them, right at the point of care.

Do you have specific examples of how an Order Set has improved care or safety in your practice and/or department?

There are lots of documents that govern newborn care, and with these Order Sets we’re seeing improvements in care, specifically with safety. Now, we’re not relying on a physician to indicate what needs to be monitored, so there are considerably less gaps in care (standardized monitoring for newborns at risk of hypoglycemia and sepsis are two specific examples where we’ve seen improvements).

Any final comments you’d like to make?

We’ve been honoured to participate in this project. In medicine, you’re always learning, and this really has helped to facilitate that process for my colleagues and me. For example, there are Order Sets that you use all the time (pneumonia, asthma, for example), and there are Order Sets for conditions that are more rare, such as sickle cell disease, babies at risk for HIV infection, etc. To have a guideline that you know you can rely on for these rarer conditions is very helpful, and it helps all of us stay up-to-date.

Our dialogue with Dr. Taylor was particularly insightful, and the Think Research team is looking forward to integrating her vital feedback into further improvements to our Pediatric Order Set. Stay tuned for part two of this blog post series, as we share our subsequent discussion with Dr. Kim Rogers, a leading Obstetrician from Trillium Health Partners.

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