Implementation of disease-based standard order sets in emergency department of tertiary care hospital, Pakistan- a novel approach for enhancing patient care

Feroza Parveen Feroza Parveen,Khusro Shamim Khusro Shamim,Zainab Mazhar Zainab Mazhar,Asif Khaliq Asif Khaliq,Aisha Akram Aisha Akram,Nadeem Ullah Khan

doi:10.47391/jpma.1281

Feroza Parveen Feroza Parveen, Khusro Shamim Khusro Shamim + Show 4 more

Open Access

https://doi.org/10.47391/jpma.1281

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Abstract

To evaluate the efficacy of disease-based standard order sets in reducing time of order entry, order processing and medication dispensation in emergency department of a tertiary care hospital. The pilot study was conducted as part of a retrospective clinical audit using pre- and post-intervention design comprising data from July to September 2013 of the emergency department of a tertiary care hospital in Karachi. Data collected related to the reduction in medicine order entry, processing and dispensing time of eight common emergency conditions with standard order set. Subsequently, standard medication orders for the selected medical conditions were developed together with physicians of emergency and other specialties. Post-intervention data was collected and the two data sets were compared using SPSS version 23.0. Mean medication order entry and processing time from the physician end reduced from 67.7±22.7 seconds to 20.5±7.1 seconds. Mean medication order processing and dispensing time at pharmacist end reduced from 70.0±22.4 to 20.6±8.8 seconds. The difference between pre- and post intervention values was significant (p<0.001). Implementation of disease-based standard order set significantly improved efficiency.

Highlights

The emergency department (ED) is often considered the first point of contact for many patients[1]
After approval from the Committee(P&TC) and the institutional ethics review committee, processes evaluated were medicine order entry, processing and dispensing time of eight common emergency conditions that were selected jointly by the P&TC and the departments of Pharmacy, Emergency and Information Technology (IT) by consensus based on the frequency of presentation of these conditions in ED
Standardised pre-filled medication orders were studied for the eight conditions: road traffic accidents (RTAs), chronic liver disease, hyperkalemia, chronic obstructive pulmonary disease (COPD), aspiration prophylaxis, allergic reaction, bleeding prophylaxis, and asthma

Summary

Introduction

It is a gateway to the our health system due to lack of primary healthcare. It is one of the most sensitive and critical areas of the healthcare system and provides essential care to the ill and injured patients[1-2]. There are numerous challenges within the ED, such as over-crowding, long waiting hours, diminished resources and increased demand[3]. Patient’s expectation for quick and accurate assessment in ED, cost-effective care and timely disposition are on the rise.[4]. Both overcrowding and over-expectation leads to delays and dissatisfaction for both patients and physicians, and increases chances of error[5-6]

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