Success Story: Pre-Printed Clinical Order Sets

Dr. David Cook and Dr. Jean Maskey thought they were embarking upon a crucial updating of clinical order sets (COS) in preparation for iHealth. They embarked upon their project, funded jointly by the Health System Redesign and Facility Engagement funding, with an aim of reaching out to Hospitalists, community family physicians and various hospital specialists for their input on updating COSs. Their goal was to align order sets with current evidence and facilitate harmonization with future electronic order sets to support the future roll-out of iHealth. They didn’t expect to have their processes and relationships tested by the outbreak of the novel SARS-CoV-2. With under a week to prepare a new COVID clinical order set, the Hospitalist group developed a Draft based on the current state of knowledge about treating patients with this virus, and then engaged with multiple services and specialties to ensure widespread input in drafting this new tool. As of March 30, 2020 it has already been put in use, with much appreciation from front line staff tasked with caring for these patients!

Prior to the emergence of coronavirus, the focus was on a collaborative effort to update order sets such as the alcohol withdrawal order set. This COS is used by many different physician groups and was aligned with current evidence to replace an out of date version. In this case, input was from the literature, and hospitalists, family and emergency physicians and those whose focused practice involves treating addictions patients both locally and from the Nanaimo area. The group also developed an agitated intoxication order set as well as a methadone order set to standardize the management of these common presentations to hospital. They have been collaborating with Senior’s Health regarding their Delirium Order set, which should soon be ready for use.

In working on these COSs, the project leads realized the value of collaborating widely with practicing physicians on clinical order sets to improve both acceptance of the order set by clinicians, as well as excellence in care, by incorporating current evidence-based practices. They also recognized the challenge of having a large group of physicians participate in these processes, and saw the ability to pay physicians through the Facility Engagement funding as instrumental to the project’s success. The team performed these updates so effectively that Dr. Cook was asked by the Clinical Order Set Harmonization Team to extend his work as a physician champion of order sets in an ongoing basis.

We congratulate Drs. Cook and Maskey for their excellent work on these clinical order sets and look forward to their next initiatives!

See also the Island Health Story on this fantastic collaboration!

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