Physician Order Set Research Articles

The Role of The Registered Dietitian In The Development and Implementation of a Multi-Disciplinary Action Plan For Use With Congestive Heart Failure Patients In An Acute Care Setting

A group of sixteen healthcare professionals (including physicians, pharmacists, registered nurses, respiratory therapists, medical records personnel, and a registered dietitian (RD) were organized to design and implement a Multi-disciplinary Action Plan (MAP) for the purpose of increasing quality and consistency of care in Congestive Heart Failure (CHF) patients based on national standards for best practice. Other goals of the MAP included increased patient participation in care, and decreased medical costs by standardization of care and appropriate use of resources. The MAP design team was directed by a team of five physicians, with expertise ranging from cardiology to family practice. The team collaborated weekly over a five week period on formulating a physician order set, the actual MAP, and patient education care plan; the latter outlined the day to day treatment processes for the patient with the CHF diagnosis. The role of the RD was to provide specialized information on the Medical Nutrition Therapy care plan for the patient, the nutrition education component, necessary diet restrictions, and possible drug-nutrient interactions with medications used in treatment. The RD also assisted with the implementation phase of MAP use by educating staff, marketing the MAP to other physicians, as well as continuing to serve as a resource in the development of other MAPs. Outcomes on MAP effectiveness will be continually measured by specific clinical indicators (i.e. readmission rates, length of stay), patient, physician, and staff surveys, as well as the patient's ability to demonstrate specific teaching plan information.

Implementation of an Epidural Pain Management Program

The epidural route of administration can be used safely for acute and chronic pain control. Although most frequently used in the obstetrical setting, the epidural route has been used more recently for pain control in general surgical and oncology patients. Nursing policies, physician order sets and nursing documentation provide a consistent approach to patients receiving epidural analgesia. Continuous quality improvement helps to assure patient satisfaction and program quality.