KJ, DeRonne Implementation of computerized physician order entry is associated with increased thrombolytic administration for emergency department patients with acute ischemic stroke. If there is a checked order that you DO NOT want, please strike through the order. Active cancer (including patients with local or distant metastases or who within the past 6 months have had chemotherapy or radiotherapy), Previous VTE (excludes superficial vein thrombosis), Reduced mobility (includes bed rest with bathroom privileges for at least 3 days), Acute myocardial infarction or ischemic stroke, Acute infection and/or rheumatologic disorder. Uses the acronym CF for what is assumed to be confidence interval but does not define it. The time to first administration of a betaagonist and first administration of a steroid did not decrease during the study period and remain critical objectives for further quality improvement efforts to improve our asthma outcomes. (p11), These findings demonstrate that as the multidisciplinary care team was able to decrease the length of stay for patients treated for asthma in the facility, these efforts did not cause a concomitant increase in readmission rates by discharging patients too soon with respect to their clinical status and readiness to go home (p10), Female (n, [%]; no SOS vs. SOS): 141 [39] vs. 106 [39], P = 0.65, PRISM Score (median; no SOS vs. SOS): 2 vs. 2, P = 0.31, Age (month; no SOS vs. SOS): 2 vs. 3, P = 0.11, Weight (kg; no SOS vs. SOS): 5.1 vs. 6.1, P = 0.01, Initiation of EN within 48 hours (%), no SOS vs. SOS, Time to initiation of EN (median, days), no SOS vs. SOS, Time to achievement, (median, days): 2.8 vs. 2.2, P < 0.0001, Children reaching goal EN (%): 18 vs. 38, P < 0.01, Total hospital LOS (median, days): 8.4 vs. 8.7, P = 0.93, PICU stay (median, hours): 202 vs. 156, P < 0.0001. ~6030-E400, Stroke Clinical Pathway Orders. No significant difference in hypertension, diabetes, CHF, coronary artery disease, obstructive sleep apnea. While care has been taken to ensure that the information prepared by CADTH in this document is accurate, complete, and up-to-date as at the applicable date the material was first published by CADTH, CADTH does not make any guarantees to that effect. Retrospective study design does not consider impact of time on groups care from pre-intervention may differ slightly from care in post-intervention (i.e., history threats to validity). Fast Download speed and no annoying ads. Eight SOSs were delivered in an electronic format,10,1417,19,21 with six studies exclusively including an SOS in a CPOE.9,1517,19 Three studies used a combination of paper-based and electronic SOSs,12 or originally started with paper-based SOSs and switched to electronic during the study period.13,20 Two studies used exclusively paper-based or pre-printed SOSs.8,18 One study did not specify the format of the order set.11, All studies compared SOSs to ordering without a SOS.821 The majority of these studies defined their comparator as no order sets, usual care, or pre-implementation.1012,1420 Two studies compared SOSs to non-standardized/diverse order sets,13 or handwritten orders,8 and one study compared SOSs within an electronic health record (EHR) to solely CPOE without order sets.21 One study compared SOSs within CPOE and EHR to solely EHR with no CPOE/SOS.9, Six studies reported on hospital length of stay,10,11,14,16,17,19 seven studies on readmission rates,10,11,13,14,16,17,19 and seven on mortality.810,16,17,19,21 Other reported outcomes included rate of prescribing errors,8,10 changes to symptom management or medications,18,20 appropriate medication dosages or monitoring,12,15,20 complications810,12 comfort at time of death,18 and hospitalization cost per patient.11. F. What are the evidence-based guidelines regarding the use of standardized hospital order sets in the acute care setting? 11. In: Downs Liberati K, Hobbs Confounders were adjusted for or included in the data analysis of three studies.14,19,20 Five studies did not include a statistical analysis of demographic information,9,10,13,15,20 or report demographics,11 so the extent of imbalance of confounders in the initial populations is unknown. Articles discussing CPOEs with SOSs compared with paper SOSs were excluded. Nursing Special c. *Vital Signs d. Notify Physician e. We hope you find these orders helpful in your practice. (E) Indication for intravenous insulin infusion among nonpregnant adults with hyperglycemia include: Manage Sickle Cell Pain Crises. Note: Assuming US dollars. The included non-randomized studies were critically appraised using the Downs and Black Checklist.6 Summary scores were not calculated for the included studies; rather, a review of the strengths and limitations of each included study were described narratively. CCI score used for complications but the score does not differentiate between complications that were already present and those that occurred during the hospital stay. the order to admit if he or she also fulfills one of the direct patient care roles, such as the admitting physician of record. Consider using the Padua score to guide whether patient meets criteria for DVT ppx. Spirometry data available in 70% of the patient population (66% [118/178] in the SOS and 78% [56/72] in the control group, P=0.07). Before ordering, review if there are any contraindications to DVT ppx, such as clinically significant bleeding or anticipated procedures in the subsequent 24 hours that would require the patient to not be on anticoagulation. As Ive mentioned in previous FPM articles, we do not view these as written in stone (see Using Standardized Allow Orders to Enhancing Inpatient Care, November/December 1999 and 30 Standardized Hospital Admittance Orders, October 2001). M. L. Using Standardized Admit Orders to Improve Inpatient Care, in page 30 of that issue. Its easy to imagine even the most meticulous physician making a critical slip late under night after an full day from patient take. The effects of an electronic order set on vancomycin dosing in the ED. S, Fung All 30 of the standardized admit orders developed by the Scott & White Clinic at College Station, Texas, can be downloaded below. This makes interpretation of this outcome very difficult. KJ, Kumar N. This document is prepared and intended for use in the context of the Canadian health care system. To our knowledge, this is one of the first studies to demonstrate improved, reduced LOS and 100-day hospital readmissions within a predominantly Hispanic, lower SES and publicly insured patient population. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. Assess patient readiness to quit and consult respiratory therapy for education/counseling. J, et al. One year prior to this, we had started a hospital service consisting of one of our senior staff physicians working with a second-year resident from the local family medicine residency. SH, Black [ 18]Standardized admission order sets have been used in other diseases with variable success at reducing hospital LOS. This book was released on 2010-09 with total page 160 pages. Edit the PDF document in the new dashboard which includes a full set of PDF tools. SR, Ospina ~6010-E003, Critical Care Pain/Sedation Orders During Mechanical Ventilation. In: Canadian Nursing Informatics Association; 2009: Grissinger Each cluster acted as its own control, with multiple clusters analysed. These comprised 14 non-randomized studies. What is the cost-effectiveness of the use of standardized hospital order sets in the acute care setting? The effect of implementation of standardized, evidence-based order sets on efficiency and quality measures for pediatric respiratory illnesses in a community hospital. Unknown if selection bias present in the groups. Many of these patients problems were relatively routine, while others were less common or more complex and, therefore, more difficult for our admitting physicians to manage. Were currently have 29 admission orders ensure cover to conditions our family physicians most frequently encounter inside the hospital. The comfort measures order set at a tertiary care academic hospital: is there a comparable difference in end-of-life care between patients dying in acute care when CMOS is utilized? See permissionsforcopyrightquestions and/or allow requests. 12. The cut-off for small sample size was not determined a priori. *Note: mortality decreased significantly in this study. Although no evidence on cost-effectiveness was identified, in one study, hospitalization costs associated with the SOS (US$1174) for pneumonia, bronchiolitis, and asthma were lower in comparison to no SOS (US$2010), but this was not statistically tested.11. The orders were then formatted using a standard template to ensure that routine issues such as diet, activity, prn medications, etc., were covered. In reply. J, Shoolin Ask about any supplements, herbal medications, or over the counter medication use. Assess patients use of tobacco. This book was released on 2010-09 with total page 160 pages. Evidence from fourteen non-randomized studies suggest that standardized order sets implemented in the acute setting reduced hospital length of stay, reduced mortality, and reduced medication errors. Results written in a misleading way e.g., The binary logistic regression method revealed that 1.8% of patients in the order set group died versus 3.2% in the free text group (p821) This seems like the number of deaths in each group came from a regression model, when in actuality they came from ICD-9 codes in the patient files. Fourteen non-randomized studies were identified regarding SOSs in the acute setting.821 Seven studies examined patients with respiratory conditions,10,11,13,14,17,21 and two with diabetic conditions.12,20 The remaining studies examined patients undergoing laryngectomy,8 EOL care,18 ischemic stroke care,9 CHF care,16 or receipt of vanomycin.15 Overall, SOSs significantly lowered hospital LOS when compared to no order sets. Implementation and evaluation of a diabetic ketoacidosis order set in pediatric type 1 diabetes at a tertiary care hospital: a quality-improvement initiative. admission order sets are rarely patient-specific but account for a significant portion of nursing and physician communica-tion. While patients and others may access this document, the document is made available for informational purposes only and no representations or warranties are made with respect to its fitness for any particular purpose. No filters were applied to limit the retrieval by study type. Admission/Transfer orders Admit to ICU, inpatient status Transfer to Acute Care Facility Patient Care x Vital Signs q15m x2 hrs, then q30 min x6hrs, then q1h x16hrs, then per protocol x Neuro Assessment q15m x2 hrs, then q30 min x6hrs, then q1h x16hrs, then per protocol x NIHSS on admission and with any neuro changes Strict NPO If a patient may need future dialysis, check-in with a Renal consultant before ordering a PICC. 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