Many industries use the good old fashioned checklist to get things done. Now KGH is busy generating some “to do” lists of our own for the bedside. They're called “order sets” and they're all about improving the care we deliver to our patients. This replaces the old process of pre-printed orders.
“Order sets are a series of forms that are created to promote best practices and save time,” says Dr. John Drover, Critical Care Program Medical Director and chair of the Order Set Committee. “They walk our health-care providers through a list of things to consider for each patient. This way the best treatment options are always considered and none are overlooked or forgotten.”
The new order sets are now being used in two departments, critical care and surgery. Work is underway to bring them to four more areas over the next month or so.
Drover says a good example of the new system in action is the admission order set that comes into play when a patient arrives in the intensive care unit. It starts by identifying who the patient is, lists their allergies or food sensitivities and then takes the physician, nurse practitioner or other providers through a list of treatment options, from pain management and monitoring equipment to the taking of vital signs. The order set clearly spells out what the best practices are and what the first choices should be. This saves providers the step of having to look things up and also frees them from having to write out instructions by hand.
“Sometimes it may not require anything more than a signature at the bottom of the order set, or sometimes it may mean making some choices between therapies, so you make a choice and then you sign,” says Drover.
KGH isn't the only hospital now using these checklists. We are part of a group of about 30 hospitals in Ontario who have signed on to an order set program created by a critical care physician at Trillium Health Centre in Mississauga. Most of the organizations involved are large community hospitals. KGH and Hamilton Health Sciences are the two big research and teaching hospitals now on board.
The program works by creating and providing a range of order set templates across many disciplines. KGH then adapts them for use here. The new process is designed to have order sets move from development to implementation in six weeks.
“We have created teams within each of our programs to develop the order sets we feel we need,” says Drover. “A lot of work goes into defining what best practices are and then putting them into a form that everybody agrees with and will work with.”
Recently for example, orders sets for pain management and on how to prevent blood clots have been completed here. For now, they will all be on paper but electronic options are being explored.
Drover says all the upfront effort is already paying off in terms of safety and service.
“When you have an opportunity to promote the best practices while reducing variability and errors of omission, it's best to take full advantage of it and that's just what we're doing with this.”
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