Standardized Hospital Order Sets in Acute Care: A Review of Clinical Evidence, Cost-Effectiveness, and Guidelines [Internet]

Excerpt

In the acute setting, physicians or other providers frequently hand write orders for treatment. These handwritten orders can be ineligible or inappropriate (leading to medication errors), or can create variability in patient care between physicians and patients that is not explained by the patients’ condition.

Standardized order sets (SOSs) are clinical decision support tools that aim to help physicians prescribe appropriate treatments using a pre-defined set of applicable drugs and recommended dosages, based off evidence-based guidelines for a specific disease area. SOSs, whether they are inputted electronically (such as through a computerized provider order entry [CPOE] system) or through paper orders, have the potential to reduce medication errors, reduce unnecessary clarification calls between physicians and pharmacists, increase the use of evidence based care, and increase efficient workflow. Additionally, the creation and use of order sets can provide an opportunity to educate physicians on best practices, or to provide reminders on appropriate prescribing and treatment. It is recommended that order sets are complete for the condition they are intended for, reflect the best practice for the disease area, stay up to date on best practices, and are standardized across practitioners.

Despite the potential benefits of SOSs, there can be challenges to implementation. SOSs can have a high initial implementation cost, disrupt regular operations in the hospital setting, and be met with push back from users.^, Hospitals may require a clear benefit of SOSs before investing the time, cost, and effort into implementation.

The objective of this report is to summarize the evidence regarding the clinical and cost effectiveness of SOSs for use in the acute setting, and to summarize evidence-based guidelines and recommendations regarding SOSs. This is to support decision making with regards to the implementation of SOSs in the acute setting, such as in tertiary, community, and regional hospitals, and across multiple jurisdictions.

This report expands on a previous CADTH report, “Standardized Hospital Order Sets in Acute Care: Clinical Evidence, Cost-Effectiveness, and Guidelines”, published in 2019.