COPD Order Set Development

Project Details

  • Departments/Divisions: Hospitalist Medicine
  • Physician Leads: Dr. Megan Milliken, Hospitalist Medicine
  • Budget: $16,248.00

About the Project

Recognizing the need to update and disseminate a Clinical Order Set (COS) used for treating patients with Chronic Obstructive Pulmonary Disease (COPD), a group of hospitalists, led by Drs. Megan Milliken, Anne McHale, Jean Maskey, and Shauna Tierney set out to work on the order set in consultation with Respirology, Internal Medicine, Medical Microbiology, Emergency Room Physicians (ERPs), Pharmacists, and several departments within Island Health, as well as the physiotherapy and respiratory therapists, and nursing on the respiratory ward. Updates to the order set included better linkages between departments and with community resources, updating the form to be compatible with i-Health, as well as flagging patients who might benefit from the home health monitoring.

Having consulted with the relevant departmental stakeholders, the physicians were piloting the form when they became aware of the need to work through the Medicine Quality Council and the Clinical Order Set Coordinator at Island Health. The project might have stalled at this point if funding had not been available for physicians’ dedicated time to continue with the necessary consultations and linkages. However, the availability of funding to compensate physicians for coming in for meetings on their days off meant that key discussions were completed and the clinical order set was uploaded to the COS repository for use by all island physicians.

The final form has been formally available since early 2019 and anecdotal reports suggest it is improving the quality of care. Other departments have been encouraged to use this process as a template for their own efforts to develop order sets. A more formal feedback survey is currently being circulated to hospitalists to explore their use of this order set, and inform future efforts.


Earlier this year, Drs. Shauna Tierney, Megan Milliken, Anne McHale, and Jean Maskey worked with Island Health colleagues to develop and formalize a Clinical Order Set (COS) for treating patients with Chronic Obstructive Pulmonary Disease (COPD).

Reflecting the cumulative expertise of multiple physician stakeholders as well as a breadth of Island Health departments including the Medicine Quality Council, Decision Support, and the Clinical Order Set Coordinator Alison Steinbart, the final product was adopted by the Medicine Quality Council as the official COPD Clinical Order Set for the entire Health Authority. It was put into an IHealth compatible format and is now accessible regionally on the intranet.

As a final evaluation of the success of this initiative, a satisfaction survey was circulated among South Island Hospitalists to measure its efficacy, uptake, and accessibility. 71% of those who responded were satisfied with the new order set, and over one third (39%) reported that their confidence in caring for COPD patients has improved as a result of using the order set. Improvements to the form as well as to its distribution channels are being undertaken.

We congratulate these hospitalists for undertaking this process and for the success of this initiative!


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