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"order set" or "order sets" or "carepath" or "care path"

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https://www.readbyqxmd.com/read/28437224/structure-process-and-culture-of-intensive-care-units-treating-patients-with-severe-traumatic-brain-injury-survey-of-centers-participating-in-the-american-college-of-surgeons-trauma-quality-improvement-program
#1
Aziz S Alali, Victroia McCredie, Todd G Mainprize, David Gomez, Avery B Nathens
Outcome after severe traumatic brain injury (TBI) differs substantially between hospitals. Explaining this variation begins with understanding the differences in structures and processes of care, particularly at intensive care units (ICUs) where acute TBI care takes place. We invited trauma medical directors (TMDs) from 187 centers participating in the American College of Surgeons Trauma Quality Improvement Program to complete a survey. The survey domains included ICU model, type, availability of specialized units, staff, training programs, standard protocols and order sets, approach to withdrawal of life support, and perceived level of neurosurgeons' engagement in the ICU management of TBI...
February 15, 2017: Journal of Neurotrauma
https://www.readbyqxmd.com/read/28434457/system-changes-to-implement-the-joint-commission-tobacco-treatment-tob-performance-measures-for-improving-the-treatment-of-tobacco-use-among-hospitalized-patients
#2
Donna Shelley, Keith S Goldfeld, Hannah Park, Ana Mola, Ryan Sullivan, Jonathan Austrian
BACKGROUND: In 2012 The Joint Commission implemented new Tobacco Treatment (TOB) performance measures for hospitals. A study evaluated the impact of a hospital-based electronic health record (EHR) intervention on adherence to the revised TOB measures. METHODS: The study was conducted in two acute care hospitals in New York City. Data abstracted from the EHR were analyzed retrospectively from 4,871 smokers discharged between December 2012 and March 2015 to evaluate the impact of two interventions: an order set to prompt clinicians to prescribe pharmacotherapy and a nurse-delivered counseling module that automatically populated the nursing care plan for all smokers...
May 2017: Joint Commission Journal on Quality and Patient Safety
https://www.readbyqxmd.com/read/28344140/high-value-cost-conscious-care-iterative-systems-based-interventions-to-reduce-unnecessary-lab-testing
#3
Brett W Sadowski, Alison B Lane, Shannon M Wood, Sara L Robinson, Chin Hee Kim
BACKGROUND: Inappropriate testing contributes to soaring health care costs within the United States and teaching hospitals are vulnerable to providing care largely for academic development. Via its 'Choosing Wisely' campaign, the American Board of Internal Medicine recommends avoiding repetitive testing for stable inpatients. We designed systems-based interventions to reduce laboratory orders for patients admitted to the wards at an academic facility. METHODS: We identified the computer-based order entry system as an appropriate target for sustainable intervention...
March 23, 2017: American Journal of Medicine
https://www.readbyqxmd.com/read/28338247/impact-of-diabetic-ketoacidosis-management-in-the-medical-intensive-care-unit-after-order-set-implementation
#4
Benjamin Laliberte, Siu Yan Amy Yeung, Jeffrey P Gonzales
OBJECTIVE: To determine the rate of compliance to the 2006 and 2009 ADA DKA guidelines in the medical intensive care unit (MICU) at a large academic medical centre after the implementation of a computerised DKA order set and protocol. METHODS: Retrospective chart review of adult patients with DKA admitted to the MICU. Results of pre-order set (PRE) were compared to those of data post-order set (POST). The primary outcome was a composite administration of intravenous fluid resuscitation in the first 24 h, insulin bolus and initial insulin infusion rate...
March 24, 2017: International Journal of Pharmacy Practice
https://www.readbyqxmd.com/read/28334581/a-gap-analysis-needs-assessment-tool-to-drive-a-care-delivery-and-research-agenda-for-integration-of-care-and-sharing-of-best-practices-across-a-health-system
#5
Sherita Hill Golden, Daniel Hager, Lois J Gould, Nestoras Mathioudakis, Peter J Pronovost
BACKGROUND: In a complex health system, it is important to establish a systematic and data-driven approach to identifying needs. The Diabetes Clinical Community (DCC) of Johns Hopkins Medicine's Armstrong Institute for Patient Safety and Quality developed a gap analysis tool and process to establish the system's current state of inpatient diabetes care. METHODS: The collectively developed tool assessed the following areas: program infrastructure; protocols, policies, and order sets; patient and health care professional education; and automated data access...
January 2017: Joint Commission Journal on Quality and Patient Safety
https://www.readbyqxmd.com/read/28325206/improving-glycemic-control-safely-in-non-critical-care-patients-a-collaborative-systems-approach-in-nine-hospitals
#6
Gregory A Maynard, Diana Childers, Janet Holdych, Heather Kendall, Tom Hoag, Karen Harrison
BACKGROUND: Practice variations in insulin management and glycemic adverse events led nine Dignity Health hospitals to initiate a collaborative effort to improve hypoglycemia, uncontrolled hyperglycemia, and glycemic control. METHODS: Non-critical care adult inpatients with ≥4 point-of-care blood glucose (BG) readings in a ≥2-day period were included. Balanced glucometric goals for each hospital were individualized to improve performance by 10%-20% from baseline or achieve top performance derived from Society of Hospital Medicine (SHM) benchmarking studies...
April 2017: Joint Commission Journal on Quality and Patient Safety
https://www.readbyqxmd.com/read/28323688/challenges-of-inpatient-glycemic-control
#7
Sally O Gerard, Josephine Ritchie
Hyperglycemia occurs in more than 30% of hospitalized patients. The condition has been associated with higher mortality and poor outcomes. Systems to effectively treat dysglycemia have been put into place, although many focus on critical care areas. The purpose of this article is to provide an overview of the challenges for glycemic control in non-critical care areas. Standardized order sets, critical pathways, professional education, and collaborative systems can support improved control.
March 20, 2017: Journal of Nursing Care Quality
https://www.readbyqxmd.com/read/28321988/a-quality-improvement-initiative-to-optimize-dosing-of-surgical-antimicrobial-prophylaxis
#8
Thomas J Caruso, Ellen Wang, Hayden T Schwenk, David Scheinker, Calida Yeverino, Mary Tweedy, Manjit Maheru, Paul J Sharek
BACKGROUND: The risk of surgical site infections is reduced with appropriate timing and dosing of preoperative antimicrobials. Based on evolving national guidelines, we increased the preoperative dose of cefazolin from 25 to 30 mg·kg(-1) . This quality improvement project describes an improvement initiative to develop standard work processes to ensure appropriate dosing. AIMS: The primary aim was to deliver cefazolin 30 mg·kg(-1) to at least 90% of indicated patients...
March 21, 2017: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/28321301/early-aspirin-administration-post-coronary-artery-bypass-graft-surgery-changing-hospital-culture-through-a-two-cycled-audit
#9
Shefali Parikh, Justin Ratnasingham
"Early Aspirin" or a medium dose of aspirin 6 hours after Coronary Artery Bypass Graft (CABG) Surgery is strongly recommend by international guidelines (EACTS 2007/AHA 2011 guidelines, Level1a evidence) to protect venous graft patency. However, compliance with Early Aspirin prescription at our centre is poor due to long standing hospital cultural practices and lack of awareness. We completed a two-cycled retrospective audit of 53 (September 2015 Baseline), 65 (January 2016 First Cycle) and 58 (June 2016 Second Cycle) consecutive CABG patients...
2017: BMJ Quality Improvement Reports
https://www.readbyqxmd.com/read/28315535/high-dose-interleukin-2-evaluation-of-a-standardized-order-set-for-biotherapy-in-an-intensive-care-unit%C3%A2
#10
Rusticio Portillas, Barbara Turner, Audrey Jeffers, Lee-Lynn Chen, Mary Champagne
BACKGROUND: Life-threatening toxicity may result from administration of high-dose (HD) interleukin-2 (IL-2). Patients receiving HD IL-2 treatment often experience severe adverse side effects, which result in the interruption of treatment. 
. OBJECTIVES: A standardized order set (SOS) was developed for patients with melanoma or renal cell carcinoma receiving HD IL-2. The aims of the study were to determine compliance of clinicians to the SOS, report the completed doses and major side effects of HD IL-2, and document the satisfaction level of clinicians...
April 1, 2017: Clinical Journal of Oncology Nursing
https://www.readbyqxmd.com/read/28292304/design-and-implementation-of-electronic-health-record-integrated-clinical-prediction-rules-icpr-a-randomized-trial-in-diverse-primary-care-settings
#11
David A Feldstein, Rachel Hess, Thomas McGinn, Rebecca G Mishuris, Lauren McCullagh, Paul D Smith, Michael Flynn, Joseph Palmisano, Gheorghe Doros, Devin Mann
BACKGROUND: Clinical prediction rules (CPRs) represent a method of determining individual patient risk to help providers make more accurate decisions at the point of care. Well-validated CPRs are underutilized but may decrease antibiotic overuse for acute respiratory infections. The integrated clinical prediction rules (iCPR) study builds on a previous single clinic study to integrate two CPRs into the electronic health record and assess their impact on practice. This article discusses study design and implementation of a multicenter cluster randomized control trial of the iCPR clinical decision support system, including the tool adaptation, usability testing, staff training, and implementation study to disseminate iCPR at multiple clinical sites across two health care systems...
March 14, 2017: Implementation Science: IS
https://www.readbyqxmd.com/read/28289608/management-of-chronic-non-healing-wounds-by-hirudotherapy
#12
REVIEW
Arsheed Iqbal, Afroza Jan, M A Wajid, Sheikh Tariq
A chronic wound is a wound that does not heal in an orderly set of stages and in a predictable amount of time or wounds that do not heal within three months are often considered chronic. Chronic wounds often remain in the inflammatory stage for too long and may never heal or may take years. Chronic wound patients often report pain as dominant in their lives. Persistent pain is the main problem for patients with chronic ulcers. Many wounds pose no challenge to the body's innate ability to heal; some wounds, however, may not heal easily either because of the severity of the wounds themselves or because of the poor state of health of the individual...
January 2017: World Journal of Plastic Surgery
https://www.readbyqxmd.com/read/28283207/perceptions-of-caring-for-adolescents-with-eating-disorders-hospitalized-on-a-general-pediatric-unit
#13
Whitney Harken, Joan Maxwell, Margaret Hainline, Lauren Pollack, Cristine Roberts
PURPOSE: To describe the perceptions of inpatient pediatric hospitalist physicians (HPs), registered nurses (RNs), and care assistants (CAs) at a tertiary pediatric hospital regarding caring for children with eating disorders (EDs) who are hospitalized for medical stabilization. DESIGN AND METHODS: A qualitative descriptive study was conducted using semi-structured individual interviews with aforementioned health care workers (HCWs) to explore their perspectives on caring for children/adolescents with EDs in relation to recent initiatives to transform their care...
March 7, 2017: Journal of Pediatric Nursing
https://www.readbyqxmd.com/read/28281949/silver-diamine-fluoride-treatment-considerations-in-children-s-caries-management
#14
Yasmi O Crystal, Richard Niederman
By arresting and preventing caries, silver diamine fluoride (SDF) offers an alternate care path for patients for whom traditional restorative treatment is not immediately available. Current data from controlled clinical trials encompassing more than 3,900 children indicate that biannual application of SDF reduces progression of current caries and risk of subsequent caries. The purpose of this paper was to highlight the best evidence from systematic reviews and clinical trials for clinicians to consider the benefits, risks, and limitations as they implement silver diamine fluoride therapy on young children...
November 15, 2016: Pediatric Dentistry
https://www.readbyqxmd.com/read/28277414/implementation-of-an-electronic-clinical-decision-support-tool-for-pediatric-appendicitis-within-a-hospital-network
#15
Marissa A Hendrickson, Andrew R Wey, Philippe R Gaillard, Anupam B Kharbanda
OBJECTIVES: Computed tomography (CT) has been widely used in the evaluation of children with suspected appendicitis, but concerns about ionizing radiation have increased interest in ultrasound for these patients. We sought to assess the effectiveness of an appendicitis electronic clinical decision support (E-CDS) system in increasing ultrasound and decreasing CT use in children evaluated in emergency departments (EDs) for suspected appendicitis. METHODS: This was a preintervention and postintervention analysis of an E-CDS implemented into an electronic health record system shared by an academic, tertiary-care children's hospital and a community hospital...
March 9, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/28271120/code-status-reconciliation-to-improve-identification-and-documentation-of-code-status-in-electronic-health-records
#16
Viral G Jain, Peter J Greco, David C Kaelber
BACKGROUND: Code status (CS) of a patient (part of their end-of-life wishes) can be critical information in healthcare delivery, which can change over time, especially at transitions of care. Although electronic health record (EHR) tools exist for medication reconciliation across transitions of care, much less attention is given to CS, and standard EHR tools have not been implemented for CS reconciliation (CSR). Lack of CSR creates significant potential patient safety and quality of life issues...
March 8, 2017: Applied Clinical Informatics
https://www.readbyqxmd.com/read/28244583/the-application-of-the-diagnostic-therapeutic-care-pathway-for-the-geriatric-patient-with-anemia-at-the-hospital-of-cosenza-italy-a-management-tool-or-a-quality-project
#17
M Loizzo, O Cuccurullo, F Gallo
BACKGROUND: Many studies in literature, indicate that the prognosis of hospitalized elderly patients is substantially related to the presence of concomitant diseases (multi-morbidity) along with physical, cognitive, biological and social functional impairments. These patients, therefore, require the expertise of a multi-professional and multi-disciplinary team operating in a Multi Dimensional Rating (MDR). MDR explores the multiple facets of the elderly and it is considered the tool of choice to define prognosis, especially in the case of compromised elderly patients with clinical or functional problems...
March 2017: Annali di Igiene: Medicina Preventiva e di Comunità
https://www.readbyqxmd.com/read/28243439/optimizing-the-electronic-health-record-to-standardize-administration-and-documentation-of-nutritional-supplements
#18
Sandra W Citty, Amir Kamel, Cynthia Garvan, Lee Marlowe, Lynn Westhoff
Malnutrition in hospitalized patients is a major cause for hospital re-admission, pressure ulcers and increased hospital costs. Methods to improve the administration and documentation of nutritional supplements for hospitalized patients are needed to improve patient care, outcomes and resource utilization. Staff at a medium-sized academic health science center hospital in the southeastern United States noted that nutritional supplements ordered for patients at high risk for malnutrition were not offered or administered to patients in a standardized manner and/or not documented clearly in the electronic health record as per prescription...
2017: BMJ Quality Improvement Reports
https://www.readbyqxmd.com/read/28238154/the-gestio-protocol-experience-safety-of-a-standardized-order-set-for-subcutaneous-insulin-regimen-in-elderly-hospitalized-patients
#19
Alessandro Franchin, Alberto Maran, Daniela Bruttomesso, Maria L Corradin, Francesco Rossi, Federica Zanatta, Gian-Maria Barbato, Nicola Sicolo, Enzo Manzato
BACKGROUNDS: In non-critical hospitalized patients with diabetes mellitus, guidelines suggest subcutaneous insulin therapy with basal-bolus regimen, even in old and vulnerable inpatients. AIM: To evaluate safety, efficacy, and benefit on clinical management of the GesTIO protocol, a set of subcutaneous insulin administration rules, in old and vulnerable non-ICU inpatients. METHODS: Retrospective, observational study. Patients admitted to Geriatric Clinic of Padua were studied...
February 25, 2017: Aging Clinical and Experimental Research
https://www.readbyqxmd.com/read/28210553/impact-of-value-based-breast-cancer-care-pathway-implementation-on-pre-operative-breast-magnetic-resonance-imaging-utilization
#20
Devina K S McCray, Stephen R Grobmyer, Holly J Pederson
BACKGROUND: Bilateral breast magnetic resonance imaging (MRI) is commonly used in the diagnostic workup of breast cancer (BC) to assess extent of disease and identify occult foci of disease. However, evidence for routine use of pre-operative MRI is lacking. Breast MRI is costly and can lead to unnecessary tests and treatment delays. Clinical care pathways (care paths) are value-based guidelines, which define management recommendations derived by expert consensus and available evidence based data...
February 2017: Gland Surgery
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