All of the changes we face as clinicians seem to relate to one simple concept, “Reducing Variation.” By reducing variation, you significantly decrease the number of potential medical errors. One of the ways to reduce variation in the provision of care is to establish a clinical order set that “guides” a physician toward the provision of proven care. The Joint Commission 2008 Hospital Accreditation Standards states that an order set provides an effective way to improve processes by reducing variance. The purpose of an order set is to acknowledge that in some clinical areas, research has proven a predominant, successful treatment regimen for the majority of patients presenting with that particular illness.

The institution of an order set will insure that clinicians provide proven treatments in the majority of cases unless there is a contraindication. The order set is also there in an effort to make the physician more efficient and eliminate the worry about omitting a proven component, like forgetting to prescribe aspirin at discharge for patients presenting with Acute Myocardial Infarction. If applicable, it will also be beneficial for clinical services to consider consolidated order sets to avoid duplication of efforts. Finally, an order set ensures legibility and clear communication of your treatment plan and instructions to all members of the healthcare team.

The Baptist Health System Medical Executive Board (MEB) has chosen to implement order sets for the treatment of conditions outlined in the “Core Measures” requirements currently being required by The Joint Commission and monitored in the “Hospital Compare” public web-site. These order sets are available for all BHS Medical Staff on our Physician Portal and are ready for your use immediately.

If it is your decision to create an order set for your practice, please ensure that it is approved prior to implementation. Our order approval process begins with a review by the Chief Medical Officer, Associate CMO, and the Medical Staff Quality team. The sheer volume of current order sets found with DNUA information is staggering, and a clear indication that we are not effectively utilizing this review and approval process. One incidence of a DNUA, written in a chart, is not an automatic RFI (Recommendation for Improvement.) One DNUA found on a pre-printed order set is a show stopper. Since it cannot be determined if this was used once, or multiple times, the latter is assumed and an automatic RFI is issued.

Things to look for before you use:

• Are DNUAs present?
• Does this meet evidence based practice standards?
• Has this order set been approved?
• Are my orders for treatment clear?

To begin the order set review and approval process, please contact Fay Gregory at 297-8260 or e-mail us at FUSION@baptisthealthsystem.com