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Margie Kennedy

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  • OS30 - What's New in Medication Management (ID 51)

    • Event: e-Health 2019 Virtual Meeting
    • Type: Oral Session
    • Track: Clinical and Executive
    • Presentations: 1
    • Coordinates: 5/29/2019, 10:30 AM - 12:00 PM, Room 200 C
    • OS30.04 - Digital Order Sets: Change, Challenge, and Success in NW LHIN (ID 407)

      Margie Kennedy, Gevity Consulting Inc.; Halifax/CA

      • Abstract
      • Slides

      Quality of care is a key initiative across Ontario with significant effort directed at establishing standardized levels of care and metrics for evaluation and ensuring that evidence-based support is available to clinicians and leaders to inform quality initiatives. Health Quality Ontario (HQO) is the provincial advisory body that defines quality, analyzes quality dimensions across Ontario, and creates education and practice materials to support the achievement of quality care. As part of this effort, expert advisory panels were assembled to develop comprehensive handbooks guiding Quality?Based Procedures (QBPs) to foster sharing best practices enabling improved quality, efficiency, and outcomes. The Northwest Local Health Integration Network (NW LHIN), established in June 2005, is headquartered in Thunder Bay and includes Thunder Bay and Rainy River Districts and most of the Kenora District. With the support of hospital Chief Executive Officers (CEOs), clinicians approached the NW LHIN seeking to establish a project to advance the implementation and adoption of digital order sets as the NW LHIN hospitals continue to work towards standardization of clinical pathways. Electronic order sets act as checklists that contain current evidence-based, best practice treatment options in a single document that follows the cognitive flow of a clinician and in Ontario, QBP handbooks were used to inform the development of standardized digital order sets. The purpose of this presentation is to share the journey of adopting digital order sets at Thunder Bay Regional Health Sciences Centre and across the NW LHIN.

      A collaborative process of development, refinement, local adaptation and approvals is essential to success and requires a well conceptualized and executed change management approach. A change management team was established at the TBRHSC, consisting of the champion, project leader, and two part-time trainers/implementation quality resources. It took an average of 5 weeks to hit milestones and approximately 9 months overall to implement a digital order set. Essential steps in the implementation process included targeted training at convenience times, champion support, active follow up on adherence gaps, remedial training and support, and regular walkabouts to foster enthusiasm and awareness among all staff.

      At present, the NW LHIN, together with its champions and partners, has translated more than 40 QBPs into digital order sets, with the most recent being the opioid order set currently in pilot phase. More than 83 hospitals in the LHIN are participating in the digital order set initiative. What was also discovered is that a standardized change approach is not optimal for a distributed network of hospitals that have significantly differing contexts. While the shared goals of quality are consistent, change approaches in less urban areas must be more customized and supported recognizing local resource and capacity constraints.

      Order sets have been shown to improve patient safety and outcomes (including a reduction in avoidable 30-day readmissions) in hospitals and outpatient clinics in several studies. Significant progress has been achieved across the NW LHIN to inspire continued effort and customization of change approaches ensuring that all sites in the NW LHIN benefit from this innovation.

      140 Character Summary:
      Digital order sets are a critical way to improve quality care through standardization, best practice, current research, and customization to the local context.

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