To: Various Committee Meetings and Departments in GBHS, HDH, SBGHC

From: Andrea Rawn,Coordinator Evidence-Based Care Program

Chair GBHN Order Set Committee

Date: July 5, 2012

RE: July 2012Reportfrom GBHN Evidence Based Care Program and Order Set Committee

Please note that all Order Sets developed MUST have a clear physician/department based stakeholder(s) list. Protocols may be developed, but are not limited to, different disciplines outlining their scope of practice, with the understanding that ALL protocols must have a physician order to initiate them and that the contents cannot be altered. All physicians are required to know the content of the protocols before initiating them.

Please also note that the policy and procedures to accompany new order sets are the responsibility of the corporations that utilize them. Stakeholders are encouraged to ensure ALL involved parties have been properly consulted and supporting documentation is in place.

NEW ORDER SETS AND PROTOCOLS RELEASED FOR USE:

GBHS – Owen Sound only – Critical Care Propofol Infusion Order Set –This order set is designed for Critical

Care only in Owen Sound around the ordering of propofol and monitoring.

GBHS – Owen Sound only – Critical Care Propofol Infusion Protocol – This protocol outlines the maintenance

and care of a patient receiving a propofol drip.

Dispensing of Insulin and Diabetes Injectable Therapy Protocol by Diabetes Educators – The protocol is

designed to allow the Diabetes Ed department members to work within their scope by dispensing insulin once a physician order is received and the delegation is received from pharmacy.

Rehabilitation Services General Admission Order Set – This order set is very straight forward in that it is an

admission to rehab listing usual procedure that occurs in those instances. Most drugs have been removed from this order set as they will be captured in the med reconciliation piece as it is completed and signed by the physician. This avoids duplication and reduces risk.

VTE Prophylaxis Order Set – The VTE Steering Committee has developed an order set to allow ALL admitted

patients to be screened for VTE prophylaxis. This order set was much debated and recently finalized. A preselected addition will be made to all appropriate order sets to ensure this important aspect of patient care is documented. Most important to this order set is the screening and indication that screening has occurred. Roll out and more information on this initiative will be undertaken beginning in September 2012.

MODIFIED ORDER SETS AND PROTOCOLS:

Acute Coronary Syndromes Admission Order Set (Non ST Elevated MI / Unstable Angina)– removal of the

Critical Care Electrolyte Protocol as an option on these order sets as it is present on the critical care admission order sets and is to be used only in critical care. By removing this option there would be no chance of it being ordered in error in areas where it does not apply.

ACS Thrombolytic Therapy Admission Order Set (ST Elevated MI)– removal of the Critical Care Electrolyte

Protocol as an option on these order sets as it is present on the critical care admission order sets and is to be used only in critical care. By removing this option there would be no chance of it being ordered in error in areas where it does not apply.

Clostridium Difficile (Recurrence) Treatment Order Set – New guidelines released for the treatment of recurrence of C-Diff do not recommend Metronidazole beyond the initial recurrence. Guidelines are attached to the revised order set as Associated Document for viewing.

Elective Pacemaker Post-Op Order Set – 12 lead ECG changed to PRN

ER Asthma – Mild to Moderate Order Set – Fluticasone removed according to 2012 chest guidelines as not eing

beneficial for ER treatment.

GBHS-OS only – Peripheral Vascular Occlusions Thrombolytic Protocol – This protocol has undergone a biannual review and the diagnostic tests have been updated accordingly. There is no longer a selection for venogram or angiogram, but rather a post thrombolytic study beyond day 2. This matches the selection in the cerner system for consistency.

IVIG Infusion Order Set – clarification on drug routes for epinephrine. Clarification in some of the wording. New mandatory form from Transfusion Ontario attached and imbedded. This form will be kept in the lab for those patients who are transfused regularly for an approved condition. This form needs updating every 6 months.

EBC Activity/Discussion:

EBC has been invited to sit on the Health Quality Ontario Advisory Panel for Congestive Heart Failure. HQO is beginning an initiative to roll out Care Pathways for the top CMG’s across the province to improve quality and to tie these to funding. How this will look is still to be determined.

The EBC program is a GBHN initiative that is a leader in the field of Pathways and Order Sets in Ontario.

The Maternal,Newborn,Child and Youth Network has launched it’s Order Set Project for this population group. In order for this initiative to be available to the clinicians in Grey and Bruce a roll-out introductory presentation will be coming in the fall. For those involved in the field of paediatrics and maternal health, please plan to attend.

Please be reminded that the search engine for the Order Set Repository is triggered by the words in the TITLE of the order set. If there are problems finding the required sets, please notify the Order Set Committee Chair at

There are upcoming changes to the template for the Order Sets. This involves adding more characters to an expanded space in an attempt to reduce the number of pages printed.

Also, ISMP recommends the use of an Arial font as some of the Times New Roman can be difficult to read. These changes will gradually implemented as other changes are made to the Order Sets and pathways themselves.

Discussion has begun on the expansion of the electonic Document in Plan, which reflects the electronic pathway. The next two to be built will include Congestive Heart Failure and COPD.

REQUESTS FOR NEW AND UNDER DISCUSSION:

Smoking Cessation Order Set

Insulin Drip/ Dose Adjustment Order Set/Protocol (outside of Critical Care)

Diabetic Ketoacidosis Order Set

Paediatric Diabetic Ketoacidosis Order Set

Fresh Frozen Plasma Order Set

Delirium Order Set

Amputation Pre and Post Op Order Set

CIWA-ar for Owen Sound ER

Post Oncology Clinic Chemo Order Set for Admitted Patients

Request for ER specific order sets

- Smoke Inhalation Treatment Order Set for ER

Wound Vac Order Set

Warfarin Dosing Protocol

ER Paediatric - Drug Endangered Child

Diabetes Pathway

Pacemaker Pathway

MEMBER CHANGES

Membership to the Order Set Committee is always open for discussion and we welcome anyone who wishes to represent the discipline in which they practice. This includes frontline staff who have an interest in becoming more involved in decision making activities.