Below we describe the importance of paying careful attention to the design and maintenance of standard order sets as well as provide examples of commonly observed problems that can lead to serious errors.
Careful attention to the content of standard order sets helps ensure they: 1) are complete, 2) include important orders be-yond what the prescriber may initially consider (e.g., specific monitoring requirements), 3) reflect current best practices, and 4) are standardized among various practitioners who provide care to patients.(1-4) Examples of frequently observed problems with the content of standard orders follow.
Order sets that include nonformulary items, drugs with therapeutic substitutions not specified, and medications that have been withdrawn from the market or have new boxed warnings that should limit their use Ensuring consistent use of well-designed order sets and maintaining the orders in accordance with best practices requires vigilance and a team approach.(4) Because standard order sets are often an important component for implementing clinical protocols, algorithms, critical pathways, and guidelines, organizations should establish an interdisciplinary process with rules to help design, evaluate, use, and maintain these orders. Rockville, MD: Agency for Healthcare Research and Quality; August 2008.With the push to develop and deploy electronic health records (EHRs) and the need for more detailed documentation, there is a growing concern in the medical community regarding the time expended to capture information-electronic or otherwise.The time providers spend during a patient visit capturing and entering data rather than focusing on the patient can be a hindrance to the quality of care.One current solution gaining popularity is the use of scribes.Scribes can provide many benefits to the practice of medicine, ultimately impacting the overall quality of healthcare delivery.
ISMP has long been an advocate for the use of standard order sets to minimize incorrect or incomplete prescribing, standardize patient care, and ensure clarity when communicating medical orders.(1-3) Whether in electronic or paper format, well-designed standard order sets have the potential to: Enhance workflow with pertinent instructions that are easily understood, intuitively organized, and suitable for direct application to current information-management systems and drug administration devices(1-4) However, if standard orders are not carefully designed, reviewed, and maintained to reflect best practices and ensure clear communication, they may actually contribute to errors—many of which have been described in our newsletters and still occur today.