Abstract 163: Implementation of a Physician Order Set Improves Adherence to Cardiac Care Unit Policy: A Quality Improvement Initiative

Abstract

Objective: To determine if using physician order sets within the electronic health record improves adherence with local policy in the Cardiac Care Unit (CCU) at University of Florida Health - Jacksonville (UFH-J) Background: In 2015, CCU at UFH-J implemented a policy to guide the utilization of wearable cardioverter-defibrillators (WCD) in patients with heart failure and ejection fraction less or equal to 35%. Adherence to this policy was sparse and needed improvement. Methods: We hypothesized that developing an electronic order set would improve adherence to existing CCU policy. The policy to be addressed was the CCU WCD policy. Pre-intervention data from January 1-June 30, 2016 was analyzed for compliance. We evaluated policy compliance in heart failure patients admitted to the CCU. On July 1, 2016, a CCU admission order set, including a section on the WCD policy, launched. The order set was developed with multi-disciplinary input from nursing, nutrition, pharmacy, and physicians. To ensure adequate time for adjustment to the order set, the post-intervention data set was collected from January 1 - June 30, 2017. Results: Implementation of the CCU admission order set resulted in a 23% absolute increase in compliance with the CCU WCD policy. Additional benefits of the implementation of the order set that were not directly evaluated in this study include standardization of initial evaluation and patient care, improvement in the selection of the appropriate diet for cardiac patients with other dietary considerations including diabetes and renal disease, and an increase in the utilization of cardiac rehabilitation upon discharge. Conclusion: Implementation of an order set is an effective way to improve adherence to patient care policy. Further studies to assess impact of physician order sets on morbidity and mortality, especially in patients with a WCD are warranted.