Dataset Information

The influence of integrating clinical practice guideline order bundles into a general admission order set on guideline adoption.

ABSTRACT: Objectives of this study were to (1) describe barriers to using clinical practice guideline (CPG) admission order sets in a pediatric hospital and (2) determine if integrating CPG order bundles into a general admission order set increases adoption of CPG-recommended orders compared to standalone CPG order sets. We identified CPG-eligible encounters and surveyed admitting physicians to understand reasons for not using the associated CPG order set. We then integrated CPG order bundles into a general admission order set and evaluated effectiveness through summative usability testing in a simulated environment. The most common reasons for the nonuse of CPG order sets were lack of awareness or forgetting about the CPG order set. In usability testing, CPG order bundle use increased from 27.8% to 66.6% while antibiotic ordering errors decreased from 62.9% to 18.5% with the new design. Integrating CPG-related order bundles into a general admission order set improves CPG order set use in simulation by addressing the most common barriers to CPG adoption.

SUBMITTER: Mrosak J

PROVIDER: S-EPMC8497878 | biostudies-literature | 2021 Oct

REPOSITORIES: biostudies-literature

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The influence of integrating clinical practice guideline order bundles into a general admission order set on guideline adoption.

Mrosak Justine J Kandaswamy Swaminathan S Stokes Claire C Roth David D Dave Ishaan I Gillespie Scott S Orenstein Evan E

JAMIA open 20211008 4

Objectives of this study were to (1) describe barriers to using clinical practice guideline (CPG) admission order sets in a pediatric hospital and (2) determine if integrating CPG order bundles into a general admission order set increases adoption of CPG-recommended orders compared to standalone CPG order sets. We identified CPG-eligible encounters and surveyed admitting physicians to understand reasons for not using the associated CPG order set. We then integrated CPG order bundles into a gener ...[more]

PMID: 34632324

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Project description:BackgroundClinical practice guidelines (CPGs) and associated order sets can help standardize patient care and lead to higher-value patient care. However, difficult access and poor usability of these order sets can result in lower use rates and reduce the CPGs' impact on clinical outcomes. At our institution, we identified multiple CPGs for general pediatrics admissions where the appropriate order set was used in <50% of eligible encounters, leading to decreased adoption of CPG recommendations.ObjectiveWe aimed to determine how integrating disease-specific order groups into a common general admission order set influences adoption of CPG-specific order bundles for patients meeting CPG inclusion criteria admitted to the general pediatrics service.MethodsWe integrated order bundles for asthma, heavy menstrual bleeding, musculoskeletal infection, migraine, and pneumonia into a common general pediatrics order set. We compared pre- and postimplementation order bundle use rates for eligible encounters at both an intervention and nonintervention site for integrated CPGs. We also assessed order bundle adoption for nonintegrated CPGs, including bronchiolitis, acute gastroenteritis, and croup. In a post hoc analysis of encounters without order bundle use, we compared the pre- and postintervention frequency of diagnostic uncertainty at the time of admission.ResultsCPG order bundle use rates for incorporated CPGs increased by +9.8% (from 629/856, 73.5% to 405/486, 83.3%) at the intervention site and by +5.1% (896/1351, 66.3% to 509/713, 71.4%) at the nonintervention site. Order bundle adoption for nonintegrated CPGs decreased from 84% (536/638) to 68.5% (148/216), driven primarily by decreases in bronchiolitis order bundle adoption in the setting of the COVID-19 pandemic. Diagnostic uncertainty was more common in admissions without CPG order bundle use after implementation (28/227, 12.3% vs 19/81, 23.4%).ConclusionsThe integration of CPG-specific order bundles into a general admission order set improved overall CPG adoption. However, integrating only some CPGs may reduce adoption of order bundles for excluded CPGs. Diagnostic uncertainty at the time of admission is likely an underrecognized barrier to guideline adherence that is not addressed by an integrated admission order set.

Project description:BackgroundIn several countries worldwide, pharmacists have integrated into the general practice setting. This has resulted in enhanced medication management, a reduction in patients' appointments with general practitioners (GPs), and decreased medication costs. However, there is a paucity of research that has focused on exploring pharmacists' views of this emerging role prior to its implementation in countries where it is not yet commonplace.ObjectiveTo explore pharmacsists' perceptions of integrating pharmacists into the general practice setting, the proposed roles for such pharmacists, and the factors affecting integration.MethodsSemi-structured interviews were conducted with pharmacists in Ireland, who were sampled based on years of experience in community pharmacy and work location using convenience and snowball sampling. The interviews were audio-recorded and transcribed verbatim, which subsequently underwent thematic analysis.ResultsTwelve pharmacists - with a median of six years' experience as a community pharmacist - were interviewed between September and October 2019. Four main themes were generated:(i) expectations of integrated role (including the importance of role definition, pharmacist experience, and increased job satisfaction);(ii) altered pharmacist-patient dynamic in primary care (including patient trust, patient safety, and the impact on community pharmacist roles);(iii) GP-pharmacist relationship (including pre-existing relationships, autonomy, reducing GP workload, and individual GP attributes);(iv) logistical issues and financial implications (including practice characteristics, co-location time, and supporting evidence-based implementation).ConclusionThis study is unique as it has focused solely on exploring pharmacists' perceptions of integrating into general practice in a country where such roles are mostly non-existent. The attitudes of pharmacists in this study were primarily positive, for reasons such as intrinsic motivation, reducing GP workload, and improving patient health outcomes. However, the routine implementation of these roles will require funding and support from key stakeholders (other than pharmacists) and should be guided by the evidence from other countries.

Dataset Information

The influence of integrating clinical practice guideline order bundles into a general admission order set on guideline adoption.

Publications

The influence of integrating clinical practice guideline order bundles into a general admission order set on guideline adoption.

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