Hospital undertakes review of preprinted MD orders

Multidisciplinary team brings them to standard

Hospitals need to ensure that their preprinted physician orders meet the appropriate standards for both safety and clinical standards. A multidisciplinary team at one hospital reviewed more than 450 of its existing preprinted orders and found that many fell short. Problems included order form content deviating from the published standards for clinical best practice, orders that did not follow pharmacy formulary, and orders that contained inappropriate symbols and abbreviations.

The team at St. Francis Hospital in Milwaukee, a 180-bed, not-for-profit community facility, also found that many of the existing orders had never been reviewed by all departments that were represented on the order. These departments included pharmacy, nursing, and laboratory.

Team members included the owner, clinical nurse specialists, and representatives from pharmacy, radiology, laboratory, and administrative support — with others having ad hoc membership, says Susan E. Samet, PharmD, formerly pharmacy clinical manager for Cardinal Health Pharmacy Management at St. Francis. Samet, now pharmacy system clinical manager at CHISTUS Spohn Health System in Corpus Christi, TX, spoke about the "development and implementation of a multidisciplinary review and approval process for preprinted physician order," at the American Society of Health-System Pharmacists Midyear Clinical Meeting, held last December in Las Vegas.

Recommended action for the review of the orders included deleting physician-specific orders and using system-based orders instead, she says. All orders needed to be routinely reviewed, follow a standard format, and undergo annual review and distribution, say Samet and her St. Francis colleague Debra A. Anczak, RPh, MS.

The team used the "plan, do, study, act model" for process improvement and initiated several changes to the review and approval process to ensure complete and consistent review and approval of all preprinted orders. The team did encounter several challenges that included a lack of a standard format for orders, required elements for a complete order, communication of changes between team members, and communication of changes to the staff members.

One solution was to flowchart the process for communication between members and revise it as needed. The process of review also was automated to ensure proper communication of intent between team members. The team developed a standardized order form template and tip sheet that removed all abbreviations, used standardized wording, and included a format for medication orders. To ensure compliance with best practices and safety issues, old orders were taken out of the facility.

The result was that more than 450 order sets were reviewed and approved to bring the hospital into compliance with regulatory standards, as well as ensuring safe clinical best practice for patients, Samet and Anczak say.