Clinical order sets are a great opportunity to improve patient outcomes and boost the quality of care within healthcare organizations, they reduce unnecessary variation and prevent omission errors.
WHO defines the quality of care as “the extent to which health care services provided to individuals and patient populations improve desired health outcomes. In order to achieve this, health care must be safe, effective, timely, efficient, equitable, and people-centered.”
What is a clinical order set?
An order set is a pre-defined template that provides point of care support in making clinical decisions for a specific condition, a medical procedure, or a workflow step. It is a grouping of orders that standardizes and expedites the ordering process for a common clinical scenario. It can be a specific diagnosis such as Type 2 diabetes, a pre, per or post-procedure bundles such as an Appendicitis procedure order set or a specific time in the patient journey such as admission or discharge order set.
Clinical order sets guide clinicians while treating patients to ensure that they do not miss any critical components of care and help them to save a considerable amount of time while ordering especially while using a CPOE (Computerized physician order entry).
What is an evidence-based order set?
An evidence-based order set is a pre-approved order set authored based on the latest scientific evidence to ensure patient safety and highest quality of care, they provide the physician with all relevant orders and reduce their reliance on memory. Order set is one of the basic building blocks of a clinical decision support system.
The usage of order sets makes the ordering process much easier for the clinician it enables standardization and serves as a reminder to order a certain test or even making them mandatory. Many examples in the literature prove the benefits of the usage of evidence-based order set.
Many clinical societies and healthcare organizations publish regularly guidelines and recommendations on how to treat certain conditions and appropriate care protocols. These publications can help build a predefined set of approved orders that will allow clinicians to be sure to follow the latest guidance and practice while placing an order for their patients.
One example is decreasing severe adverse maternal outcomes from pre-eclampsia using an order set for this condition.
Research also indicates that the use of evidence-based order sets improves compliance with recommended care processes and patient outcomes. The use of standardized order sets has also been found to reduce overall and postoperative lengths of stay and total charges for multiple surgical procedures.
Order set benefits
Order set reduces adverse events, improve patient care and safety, speed patient throughput, and increase a healthcare provider organization’s return on its investment in health information technology.
Research shows the implementation of clinical order sets improves compliance with recommended standards of care and ultimately improves patient outcomes
In one study the implementation of order sets and their integration with a CPOE has resulted in savings in the form of increased productivity for clinical staff working with order sets and CPOE, enhanced efficiency of clinical and administrative staff working in the hospital, and increased operating profit and expected incentives from Medicare’s programs.
Order set adoption
Having the order sets in the system is one thing but driving their adoption is a common challenge across the different organizations as clinicians are not forced to use them, they have the choice to use them or not, so patients do not benefit when their care provider bypass order set usage. The presence of order set in a system does not guarantee that clinicians will use them
It is important to give physicians’ input on order sets and allow them to customize specific order sets in order to enhance the adoption of CPOE.
Ensuring the consistent use of well-designed order sets and maintaining the orders in accordance with best practices requires vigilance and a team approach. Because standard order sets are often an important component for implementing clinical protocols, algorithms, critical pathways, and guidelines, organizations should establish an interdisciplinary process with rules to help design, evaluate, use, and maintain these orders.
How to increase order set usage?
Increasing Clinical Order Set usage is vital as it improves patient safety while also providing valuable metrics that can be used to gauge the organization’s clinical efficiency. Trends and insights can be captured and reviewed to determine an Order Set’s effectiveness for the organization and the patient. Upon a thorough review, changes can be made to the Order Sets to improve their performance.
Steps for successful order set
- Establish a formal governance structure: To maximize physician buy-in and satisfaction, organizations must establish a formal governance structure for the approval, review, and maintenance of Clinical Order Sets with multidisciplinary representation.
- Develop a clinical content strategy: Clinical Order Sets should represent best practices and organizational standards. This includes identifying and selecting data content sources.
- Content review, maintenance, and update: Regarding importance, the time allocated, and the resources assigned to content update and maintenance processes are integral to the success of the Order Sets. This is particularly true whenever clinical content is highly customized as it will require significantly more time and effort to maintain the customized content. There needs to be a process in place to identify and replace content that can affect patient safety or quality of care when content is outdated.
Creating and maintaining clinical order sets require ongoing evaluation and maintenance to ensure the proper data are captured in your workflows. Define the clinical order sets for your department. Integrate clinical order sets into your workflows to enhance your department’s success in providing quality, safe, and efficient patient care.
Clinical order sets providers:
Elsevier Clinical Management System
Designed by clinicians, for clinicians, the Elsevier Order Sets management system is an intuitive, cloud-based application for the authoring, reviewing and task management involved with developing and maintaining order sets.
library of over 1,000 reference order sets based on the latest clinical knowledge supports outstanding clinical decision making.
See more about think research solutions here.
ZynxOrder® provides an extensive library of actionable, evidence-based order sets and clinical decision support rules that improve inpatient outcomes by reducing risk, decision uncertainty, and practice variation.
With a full suite of collaboration tools that bring together key stakeholders for quick feedback and consensus, the software as a service (SaaS)–based system expedites order set customization and implementation processes and offers comprehensive clinical and quality improvement for hospitals
Provation clinical order set management
Provation Order Sets is an intuitive software with intelligent content gap analysis that works with or without an existing EHR system to optimize order sets management, while helping improve consistency and efficiency of care, implementation of best practices, regulatory compliance and patient outcomes.
Preeclampsia-eclampsia adverse outcomes reduction: the preeclampsia-eclampsia checklist, OB Nwanodi – Healthcare, 2016 – mdpi.com
Grissinger, M. (2014). Guidelines for Standard Order Sets. Pharmacy and Therapeutics, 39(1), 10.