Making instructions for patient care clearer, faster, safer

The team heading the implementation of the Patient Order Sets consists (from left) Bob Lapointe (IT Lead), Gosia Radaczynska (representative, Think Research), Dr. Elizabeth MacNamara (Medical Lead), Geneviève Beaudoin (Clinical Lead) and Serge Cloutier (Nursing Lead). Projected on the screen behind them is a sample Patient Order Set.
The team heading the implementation of the Patient Order Sets consists (from left) Bob Lapointe (IT Lead), Gosia Radaczynska (representative, Think Research), Dr. Elizabeth MacNamara (Medical Lead), Geneviève Beaudoin (Clinical Lead) and Serge Cloutier (Nursing Lead). Projected on the screen behind them is a sample Patient Order Set.

New digital Patient Order Sets are ready to use and customizable

Imagine that you’re a doctor and you want to issue comprehensive instructions for nurses, pharmacists, nutritionists and other members of healthcare staff who are providing care for your patient. Normally, you’d fill in a form by hand, relying on your experience and expertise to determine the measures that the healthcare team ought to implement.

Not a bad system, but hardly in step with the times.

Wouldn’t it make more sense—be faster, more accurate, more convenient and, in many instances, much safer for your patient—if you could simply open a computerized form whose predetermined, evidence-based orders cover various aspects of the ailment that your patient is being treated for? All you’d have to do is verify that the orders are appropriate; if needed, you could personalize some of them to suit your patient’s special needs.

That’s the revolutionary step the JGH is taking with the introduction of digitized Patient Order Sets. Following the project’s November launch on 5Northwest, the system will steadily be expanded to include every unit and department in the hospital.

Where appropriate, this initiative will be spread out to the JGH’s partner-institutions in the Integrated Health and Social Services University Network for West-Central Montreal (West-Central Montreal Health). Working together, they will develop and implement standards of care that are built around patient safety and efficiency.

Geneviève Beaudoin (seated), a Clinical Nurse Leader, reviews one of the new Patient Order Set with (standing, from left) Denise Bédard, a Nurse Consultant in Colorectal Surgery and Vascular Surgery; Justine De Monteiro, Interim Head Nurse on 5Northwest; and Kathryn Baldwin, a Nurse Clinician on 5Northwest.

Geneviève Beaudoin (seated), a Clinical Nurse Leader, reviews one of the new Patient Order Set with (standing, from left) Denise Bédard, a Nurse Consultant in Colorectal Surgery and Vascular Surgery; Justine De Monteiro, Interim Head Nurse on 5Northwest; and Kathryn Baldwin, a Nurse Clinician on 5Northwest.

Guiding this project is a core group consisting of Dr. Elizabeth MacNamara (Medical Lead), Geneviève Beaudoin (Clinical Lead), Serge Cloutier (Nursing Lead), and Bob Lapointe (IT Lead). Over the past several months, they have built a strong team of staff that is based on trust, mutual respect of expertise, and collaboration. The team is currently working hard to iron out the difficulties that inevitably arise in a project of such size and complexity.

Motivation and enthusiasm for the project are bolstered by the strong support of the hospital’s leaders, Dr. Lawrence Rosenberg (President and CEO of West-Central Montreal Health), Dr. Louise Miner (Director of Professional Services), Johanne Boileau (Director of Nursing) and Valérie Vandal (Associate Director of Nursing).

The company behind the Patients Order Sets’ software, Think Research, and its project manager, Gosia Radaczynska, have also been closely involved and supportive since the beginning of the project.

Dr. Rosenberg, says that in introducing the Patient Order Sets, “we want to help our physicians and healthcare staff to provide the absolute best care they can. This is a very tangible way to demonstrate the hospital’s support for its clinical enterprise and for its physicians.

“This will be done by standardizing our approach to common problems and by reducing the variation that sometimes creeps into the care of our patients. The problem with variation and a lack of standardization is that they can sometime lead us to do things that perhaps we shouldn’t be doing—or not to be doing things that perhaps we should be doing.”

Dr. Rosenberg adds that the Patient Order Sets “will make life easier for doctors, nurses and allied healthcare professionals, because everybody will be reading from the same playbook. We’ll know that for a particular medical condition, there is an agreed-upon approach, as documented in the Order Set. By eliminating the variation, we eliminate the need to run around and try to find doctors to figure out exactly what they want done.”

The digital system that the JGH is installing comes fully equipped with a database of thousands of completed Patient Order Sets, covering a vast array of diseases, illnesses and medical conditions. This data represents best practices in the numerous hospitals and other institutions that subscribe to the service, with information supplied by a legion of physicians in every specialty.

“The Order Sets are based on internationally accepted standards of care, which are kept current through continuous, ongoing review,” Dr. Rosenberg explains. “Things change so quickly that most doctors don’t necessarily have the time to do a complete review of the literature, to synthesize it or to analyze it. For this reason, the company that supplies the Order Sets performs the research, conducts the analysis, does the compilation and produces recommendations that are based on a very rigorous review of the literature.”

Dr. Miner says the Patient Order Sets even come with references, enabling physicians to consult the medical literature to better understand why a particular order is considered a best practice. “This is very empowering,” she says, “because if, for instance, a physician orders a certain test for a patient, the physician is confident that the order has been reviewed and approved, and that the hospital is saying, ‘This is what you should be doing and we will back you up.’”

“The Patient Order Sets require input from doctors in every area and specialty across our network,” says Dr. MacNamara, who is overseeing the project. “Their insights and in depth knowledge are pivotal in providing better treatment and care for our patients.” “Without their active engagement this project would not succeed” “There is a lot of effort in adapting these sets with reviewing, validating and modifying the original forms depends heavily on the participation of the hospital’s,doctors nurses and healthcare professionals to conform to the practices and procedures that have been found to work best at the JGH.

According to Ms. Beaudoin, the introduction of a digital system means that the new orders will be clearly printed and easy to follow—an improvement over handwritten orders that may sometimes be illegible or misread and, therefore, prone to potential errors.

In addition, she says, the digital orders will be updated on a continual basis to reflect the latest practices and circumstances at the JGH. For example, if the Pharmacy no longer dispenses a particular drug, the substitute medication will be indicated on the appropriate Patient Order Sets. This will eliminate any possible confusion and enable the patient to receive the medication with no unnecessary delay.

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