rates. This effected/effects patients and patient care as heparin drips are not being titrated in accordance to evidence-based practices. This has a direct impact on the patients and quality of care. This issue also results in delay of care. As the EHRs are not equipped to provide an automatic notification of new orders, efficiency is compromised as well as a patient’s trust and confidence. Not only are order sets/protocols need for heparin infusions/drips within the facility but also the treatment of sepsis, central line-associated bloodstream infections (CLABSI), and diabetic ketoacidosis (DKA). Rationale for Recommended Change The implementation of best practice is increased with the use of standardized order sets. Practice change should always be initiated for the benefit of the patient. Prioritizing patient- centeredness is the root behind improving delivery of care, accuracy, and communication. According to the Institute for Safe Medication Practices (ISMP) using order sets and/or protocols has the ability to minimize incomplete prescribing, incorrect prescribing, and reduce oversight through standardized formatting [Gri14]. Orders sets are written in accordance with best practices, reduces calls to prescribers in regards to order clarifications and/or questions about orders, and provides model for modify practice through evidence-based care. The implementation of order sets not only has impacts the quality of patient care but also has the ability to improve an organization’s core measures. Order sets/protocols are beneficial in that
INNOVATIONS 13 they are standardized, can be written with best practices and/or evidence incorporated within them, and they can act as a reminder for forgotten items such as starting a dextrose-based for patients on insulin drips or being treated for DKA. The use of standardized order sets are also backed by empirical evidence. One such study implemented in an ER using an order set for septic shock demonstrated lower 28-day mortality [Mic06]. Order sets also increases a nurses autonomy, make them more accountable for the care they provided, and increase interdisciplinary collaboration. Evaluation of Change Effectiveness Order sets/protocols are vital components to providing quality care and increasing patient safety. The Joint Commission recognizes that order sets, clinical pathways, and/or protocols, can be used to implement practice guidelines and change. Evaluation of a change process is crucial. Utilizing national performance benchmarks published by agencies such as Joint Commission, the Centers for Medicare and Medicaid Services (CMS), HCAHPS, and the NPSGs, one can evaluate the effectiveness of an improvement process change. These agencies measure performance indicators, best practices, root causes, and activity measures. The Centers for Disease Control and Prevention (CDC) has operational guidelines that require hospitals to submit data monthly in regards to certain infections, including CLABSIs, Methicillin-resistant
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