Order Set Development and Implementation

Trillium Health Centre has created a new and comprehensive evidence-based practice for the development, use, and revision of order sets/clinical protocols. (When “order set” is used in the following text, “clinical protocol” is also implied.) Any Trillium employee can propose a new order set, or a revision to an existing order set, based on whether it complies with evidence based best practices for medicine, and improves workflow, patient safety, error reduction, and compliance with best practice. Once a proposal is made, a team then develops the order set by collaborating with the Order Set Committee (OSC), and involves all stakeholders impacted by the use of the order set, which must include, at a minimum, a health system physician(s), a clinical educator, a pharmacist (if medication use is involved), and a nursing representative. When appropriate, the team consults allied health professionals, clinical content experts, staff in laboratory services and diagnostic imaging, and any other stakeholders impacted by the protocol. The OSC is responsible for ensuring that all order sets are reviewed every two years. The OSC informs the appropriate health care system when a decision support tool is due for review. Benefits of Trillium’s thorough development and implementation for order sets include • Increased use of evidence-based best practices • Improved clinician workflow, patient safety, and patient outcomes • Efficiencies in workflow and practices • Facilitating the effective use of complex treatments and investigations in patient care • Facilitating the collection and measuring of patient care metrics • Reduction in variation in clinical practices that are unrelated to patient characteristics or preferences • Reduction in adverse events • Assisting the interdisciplinary health care team to function at full scope of practice • Supporting clinical decision making without replacing clinical judgment This process was recognized by the Ontario government at the 2006 Innovations in Health Care Expo within the field of Improving Quality and Patient Safety. A partnership with Open Source Order Sets has resulted in this practice being adopted throughout Canada.