Order sets

For many common diagnoses, providers (physicians, nurse practitioners, midwives, clinical pharmacists and dentists) will be able to use pre-approved order sets.

An order set is a group of bundled standard orderables (a health care provider's instructions or directives to other health care workers regarding the treatment of a patient). These have been designed based on a condition, disease or procedure. For example, there are order sets for the treatment of sepsis, pneumonia and so on. The content of order sets can be modified or amended based on the needs of the specific patient.

Order sets are already in use across VCH, PHSA and PHC, mainly in the form of pre-printed orders. CST is standardizing order sets across the three organizations and implementing computerized provider order entry to improve accuracy, decrease adverse events and ensure that patients receive consistent, evidence-based care.

“Using order sets makes entering orders into the computer easier,” says Dr. Alain Gagnon, CST Chief Medical Information Officer, PHSA. “It allows you to pre-select from a catalogue of key things, making it faster to use computerized provider order entry (CPOE).

“It also enables standardization, such as reminders to order a certain test, or even making a test mandatory. There are many examples of improvements that come from standardization, but an example from my own field (although this was not using CPOE) was that we decreased severe adverse maternal outcomes from pre-eclampsia from 3.1% to 1.9% by using standardized order sets for the condition.”

Order sets can be tweaked to suit the individual needs of a patient, and you can save these amended sets as "favourites" to use again.

The Order Sets Team is responsible for developing the order sets, based on the best evidence available. This will help to minimize misinterpretation of handwritten orders, dosage errors and adverse drug interactions; and to ensure high-quality, safe patient care.

Dr. Dave Pledger, emergency room physician at Vancouver General Hospital, emphasizes the importance of order sets to his work.

“The order sets are comprehensive and serve to minimize errors of omission or dosing errors in the chaotic environment of the emergency department,” he says. “It allows for the rapid initiation of appropriate care with a single computer entry.”

This means improved efficiency and productivity for care teams.

Dr. Pledger worked with Dr. Eric Grafstein, CST’s Chief Medical Information Officer for VCH and PHC, to develop adult emergency department order sets.

Dr. Simi Khangura, a pediatric emergency physician at BC Children's Hospital, was the lead subject matter expert for the development of pediatric emergency order sets. She is particularly excited about how the pediatric emergency order sets can be used to positively impact the care of children presenting to all emergency departments.

"The pediatric emergency order sets are derived from evidence-based clinical practice guidelines for common pediatric complaints, such as asthma exacerbations, skin and soft tissue infections and gastroenteritis with dehydration, as well as uncommon but more critical presentations like sepsis and diabetic ketoacidosis. The order sets provide a great opportunity to share knowledge and standardize care for pediatric patients presenting to all hospitals within the three health authorities."