Many Epic clients, especially those who have been live for some time, suffer from extreme levels of order clutter. Their bloated order sets are filled with the outcomes of any number of requests over time. Nurses, especially in inpatient units, are assaulted with colossal lists of orders and have difficulty both finding what is actionable and understanding their patient's situation. It's virtually impossible for clinicians to understand what needs to be done to care for their patients at a glance, requiring them to read through every order, every time, to ensure that nothing is missed or misunderstood.
So how does an organization simplify their orders in Epic? What can be done to make order sets more consistent and less complex? How can orders and the manner in which nurses interact with them be adjusted so that they can easily see what's going on with their patients and what actions they need to perform? How can we all get rid of the clutter?
And, maybe most importantly, how can we ensure that things won't devolve back to where we started?
The process is long but the benefits are substantial - here are ten key steps we recommend:
Orders
- Verify that only things that need to be orders are built as orders
- Eliminate orders that tell nurses to do things nurses will do, anyway
- Reduce the number of orders you have that are similar and validate that synonyms are prevalent and accurate
- Streamline the ordering process by reconsidering order composer setup, defaults, and requirements
- Verify the orders are clear – you’ll likely find that many could be easier to understand with the addition of verbs
- Review the use of generic orders (i.e. nursing communication) to identify themes and create specific orders to better facilitate workflows
Order Sets
- Use consistent order groups throughout order sets
- Don't just try to recreate what you had on paper: not checking "Patient may ambulate" on a paper order sheet (the nurse sees the provider didn't check that box) is very different than not selecting the "Patient may ambulate" order in an electronic order set (the nurse may not even be aware it was an option)
- Keep the sparsely-used orders out of the standard order sets
- Standardize the sequencing of orders in your order sets and OSQs
Next Steps:
Like any complex tool, an organization's ordering process and workflows need regular maintenance and occasional tune-ups. Our experienced Orders experts at CereCore are here to help guide you through this process. We can provide advice and recommendations to simplify your orders, clean up your preference lists and order sets, and/or define an order design process to follow for future order and order set requests to prevent the bloat and confusion from returning. For more information on the ten key steps CereCore would recommend as part of simplifying your Orders in Epic, you can download our solution overview here.
To start the conversation of how we can help you clean up the orders in your system and help your clinical staff have a clear picture of their patients, please email us at info@cerecore.net or call us at 855.276.9112.
