- What is on this list that applies to your specialty or your interests?
- What, if anything, has been left out that should be included on this list?
- Imagine the day Eclipsys "goes live," with the following list of pre-written (and vetted by us) order sets available to anyone making rounds. What are the ways this will make rounding easier? What are the barriers that you anticipate to implementation?
To be clear, this is just a list of the titles of order sets which we as a group are charged with prioritizing and honing. Clicking on any of these titles will not bring you directly to the order set (yet!). Leave your comments, below, based on this list. More to follow!
General Admission Orders (ADCAVANDIMML)
General Transfer Orders
Discharge Orders
Specific Admission Orders for:
Sepsis
Stroke
TIA
ST Segment Elevation MI
Non-ST Segment Elevation MI
Congestive Heart Failure
COPD
Community Acquired Pneumonia
Health-Care Facility Related Pneumonia
Syncope
Atrial Fibrillation
Cellulitis
Osteomyelitis
Total Hip Replacement
Total Knee Replacement
Distal Bypass Surgery
Carotid Endarterectomy
Colon Resection
Hysterectomy
Gastric Banding
Gastric Bypass
Chemotherapy General Order Set
Protocols:
Specific Chemotherapy Protocols (5 top)
VTE Prophylaxis
Insulin Infusion
Weaning Protocol
Immunization (Flu)
Immunization (Pneumovax)
Thanks, as always, for ALL you do. Looking forward to your comments, and to working together with you soon.
Dear Maria: Except for the surgically related sets, they all apply to my hospital practice and look appropriate. I cannot offhand think of anything that is missing except for a general ICU/CCU admission list. Immunizations should probably be included as a member of all order sets as well as VTE prophylaxis. I feel that the fewer documents that are needed, the less likely something will be overlooked. You might have a general ortho sheet instead of specific procedures. Same with gastric bypass/banding. Pneumonia can be combined as well as vascular. Narrowing down the choices as far as sets, and having more options per set would in my mind seem preferable.
ReplyDeleteHi Maria- I would like to have ability to see the order set by clicking on it from the site and be able to add edits.
ReplyDeleteI agree that vaccines and VTE prophylaxis apply to all admissions and would also combine the cellulitis/osteo.
I would also like to see the comfort care order set listed and have it pop up anytime a patient with history of dementia is admitted.
I worry about availability of workstations as a barrier to use.
Great comments, Dan and Lorraine. And thank you for being the first two to post your recommendations and complete this assignment. I will have one of the analysts at Dr. Faro's office compile a report of the team's input, and have it available here on Maria's List, as well as at our next meeting, which should be coming up within the month.
ReplyDeleteSo, here's my two cents on this preliminary list. I am, of course, looking at this in the context of my surgical practice. Starting at the top, I think the "general orders," will either have to be more specific (by area of the hospital, or condition), or the most customizable (drop-downs to select and edit or free text boxes). Agreeing with both what Dan and Lorraine mentioned, there may be orders that are specific to ICU/CCU, step-down, tele,or even TCU - on admission and/or transfer/discharge.
ReplyDeleteSpeaking to the specificity of surgical order sets, we may have to consider our current case mix to decide which to have ready for Go-Live, as well as our ability/capacity to train the surgeons. I won't even get into the motivational issues yet, although that will most certainly have to be addressed.
Anyway, back to this list. I think we should include a few more general surgery order sets, and I think Randy Schrager would agree. Things like cholecystectomy, breast biopsy, hernias, and excision of soft tissue masses should definitely be in the mix.
Finally, regarding "Go-Live," for Eclipsys, depending on your educational and training strategy, you will need super-users who understand surgical workflows and throughput issues that are specific to the operating room, ambulatory surgery unit, PACU, ICU/CCU, step-down, PSU, 2 East, and Med-Surg floors.
A comment from Lloyd Lense:
ReplyDeleteHere is an article looking at consumerism and data reporting from a medical society . In a competitive world this may be a significant driver of patient and insurance company choices. lloyd lense
This refers to a New England Journal of Medicine Article available here http://www.nejm.org/doi/full/10.1056/NEJMp1009423
The list seems fairly complete. I'm not sure we need an order for ST elevation MI as these patients should be transferred immediately to a cath lab equipped hospital. I would also substitute Acute Coronary Syndrome for Non ST elevation MI as this would also encompass unstable angina.
ReplyDeletefor vascular surgery we also need angiogram/angioplasty/stent and AAA (open and endovascular)
ReplyDeleteHi Maria
ReplyDeleteDr. Arato has delegated the input of the OB/GYN department to me and I look forward to working with all of you to make our lives easier. In OB/GYN we have many ambulatory surgical procedures and could use an Ambulatory Post-op order set and a "23 hour" stay order set. These order sets could be created with the input of the other surgical specialties so that they can be used by all surgeons and thus avoid having an order set for each specific ambulatory procedure. Thanx, - Gus
Welcome, Gus! Great suggestions. And thank you for bearing the standard for the OB/GYN dept! I know how busy you all are. Our next meeting at Mather is Thursday, Sept 30th at 7am. I'll post it with more details as they come.
ReplyDeleteAs an anesthesiologist, I would only have need for one order set and that would be admission orders to the PACU. I do not believe that our department though is a paricipant in the first roll-out of the EMR so I think we could wait until we know we are scheduled for hardware installation. I do beleive that installation of hardware throughout the nursing stations of the entire hospital will come before system hardware for each individual OR. My bigggest gripe though is that at the last meeting on a Thursday morning, I asked if the meeetings could be moved to any other day of the week and no one seemed to voice a problem with it. I now see we are again meeeting on Thursday morning. Presently Thursday happens to be the busiest day of the week for our department and quite often we need all hands on deck to get the day started at 7 AM. Anything you could do insure that I could attend these meetings would be appreciated.
ReplyDeleteAfter this morning's meeting I have several items that need to be addressed.
ReplyDelete1) I saw on one of the screens that flashed by that there was an order set or drug choice for PCA Narcotics. This needs to be reviewed by myself and other members of the department and should possibly be limited only to the Department of Aensthesiology and Pain Management.
2) Speaking of Pain Managment, I think they might be writng standard post-procedure orders for all their block patients. I am inquiring with the nursign staff in this area as to how this occurs. Maybe if feasible, we should add an order set for post pain procedure orders and possibly get Dr. Gangat to add a physician who speciales in Chronic Pain to the PAC?
3) Someone tried to snail mail to my office the letter you e-mailed last week, but they had the wrong address. Our offfice is located in ROcky Point, NY 11778 not Setauket. Thanks!