WELL DESIGNED ORDER SETS
KEY TO LONG TERM SUCCESS
By Sheryl Sanderson
Order sets are not a new concept and have been used for many years in healthcare to simplify
and standardize complex treatment regimens. The original goal behind their development was to
standardize best practices and optimize patient care. Developed in the 1990’s, disease-specific
order sets were known by names like critical pathways or care protocols. They covered a patient’s
care from pre-admission through discharge and, in some cases, after care. Order sets in the
present day can be defined as a collection of orders designed to streamline and standardize the
electronic order entry process.
As health systems implement computerized physician order entry (CPOE) systems, clinicians are
struggling with the challenges order set create; such as, developing standard content with the
latest research by clinical experts (consensus-based vs. evidence-based), maintaining and
managing paper versions, or creating a consistent computerized format. Order sets can range in
complexity from a simple list of orderable items, to more complex orders that involve imbedded
decision making.
A key element in the overall success of CPOE is a well designed order set. In order to assure
order sets are well designed, a solid development process is essential. That process requires a
dedicated coordinator(s) who can create and maintain strong collaborative efforts between the
clinical process and the IT process.
*Standard Format Designs-Paper & Electronic:
Often times the paper orders used in developing content are arranged in a variety of formats with
little consistency in the order or sequence of the order items. Having a standard format design
can assist in the content development process, and in assuring ease and efficiency with the I.S.
configuration process. Having all order items laid out in the same sequence on paper, as well in
the electronic system, not only drives consistency, but assists with the collaboration on
content development, the clinician training process and the transition from paper to computer.
Example of a Standard Sequence design:
- PATIENT CARE
- Affirmation of consent
- Vital signs
- Resuscitation status
Activity order:
- NOTIFY MD:
- RESPIRATORY:
- NUTRITION:
- LABORATORY:
- STATs
- Routine
- DIAGNOSTIC IMAGING:
- Plain films
- CT
- Ultrasound
- MRI
- Other
- PROCEDURES:
- CONSULTS:
- EQUIPMENT:
- DISPOSITION / DISCHARGE PLANNING:
- PHARMACY:
- IV fluids/Pressure Monitoring Lines
- Infusions (Drips)
- Pain/Sedation Meds
- Scheduled Antibiotics
- Other Scheduled Meds
- PRNs
- Other
*I.S. Configuration Style Guide:
Creating a style guide of I.S. configuration design standards is another helpful step in
assuring well designed order sets.
Example of how a Style Guide could be created:
- Naming:
Standard: Site (caps), Clinical area (caps), Name, Age group (caps)
Multiform: OS form # with full name in “Description/Title”
- Numbering:
All: paper form # with latest version date as SYNONYM
Displays:
Multiform: field on the upper right corner of form (free text 25 with version Date grayed out)
Displays:
- Categories: arrange by classifications
- Browse: (consistent sequence to categories)
As the electronic order entry world continues to evolve and become more sophisticated, the
need for paper orders will diminish. However, the need to maintain paper copies still exists.
There must be processes are in place to address challenges; such as, what to do during downtime,
planned/unplanned outages, and ways to effectively communicate changes between clinicians and
IS. Creative options may include making them available on the organization’s intranet site to
print when needed, or to outsource for storage and access.
Order Sets are a key element in the overall success of computerized order entry. Well
designed order sets not only contribute to quality patient care by supporting consistent best
practice through standardization and reduction of variation, but also by reducing the likelihood
of error and ensuring efficiency. Efforts put forth in creating standard design formats and
configuration guides are well worth the time and energy to help assure long term success.
For additional information about Order Sets or VCS’ services and solutions please email us
at vcs@getvitalized.com or call us at 610.444.1233.
You can also learn more about VCS by visiting our website at www.getvitalized.com