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Order Set Harmonization

What are order sets?

Order sets play an important role in patient care, offering care providers a way to group standard orders, including medications, imaging/diagnostics and laboratory tests, together in a clinically relevant format. They represent best ordering practices for different health conditions, diseases and procedures, and play an important role in reducing unnecessary variation in patient care and effectively communicating to other members of the health care team.

At present, most order sets in use at Island Health are on paper, with the exception of sites where the Cerner electronic health record has been fully activated, such as Nanaimo Regional General Hospital (NRGH), Oceanside Health Centre, Dufferin Place, The Summit, Port Alice Health Centre and Gorge Road Long Term Care.

What is order set harmonization?

Island Health is harmonizing order sets across the region and implementing computerized provider order entry to improve accuracy, decrease adverse events and ensure that patients receive consistent, evidence-based care. This process is built around the work of subject matter experts representing medical and clinical staff from around the Island Health region, who review our existing order sets and develop new ones to support best practice for the condition of care needed.

Improving accuracy, decreasing adverse events, & standardizing care

Order set harmonization features: 

  • Coordinated approach – to addressing discrepancies between paper and electronic order sets.
  • Structured review – of all order sets to incorporate evidence-based and best practice orders and workflows. 
  • Collaboration – working groups are interdisciplinary and regional, working together to reduce unnecessary variation in clinical practice between sites and practitioners.
  • Readiness – the harmonization process helps prepare for computerized provider order entry (CPOE) by using the same order sets on paper and in the electronic health record.acc

Why harmonize order sets?

This initiative is an important contribution to quality, consistent care for patients across the region. Order set harmonization:

    • Creates consistency in patient care across Island Health
    • Reduces unnecessary variations in practice
    • Supports quality and safety standards in professional practice across the region
    • Leverages new guidelines and procedures that need to be included:
      • Opioid Safety, Antibiotic Stewardship/Sepsis, VTE Prophylaxis
      • Choosing Wisely recommendations (Lab, transfusion, DI, etc.)
    • Introduces standard terminology for both electronic and paper-based sites
    • Shortens the learning curve in preparation for CPOE go-live at tertiary sites

How will harmonization happen?

  • Establish regional SME groups led by IHealth physician leads and supported by dedicated informatics, pharmacy, and project resources.
  • Use web-based tools, such as Zynx, to review order sets efficiently, with fewer meetings.
  • Review CPOE and/or paper order sets, and collaboratively update content, workflow, and build to optimize workflows and realize better patient outcomes.
  • Apply evidence-based and best practice resources that are provided by the project team to support decisions.
  • Incorporate Island Health order set standards, guiding principles and style guides that reflect our organizational priorities and goals e.g., Choosing Wisely Canada, Opioid Stewardship, etc.
  • Track order set progress and decisions in an online tool customized to each department/division.
  • Approve order sets through order set and IHealth pathways, optimized for efficiency.
  • Implement order sets at both CPOE activated and non-activated sites. CPOE, medication safety and project teams will update CPOE content and export it into paper form.
  • After implementation, data and survey feedback will support a continuous improvement cycle for order sets.