Nursing champions of Patient Order Sets make their mark

‘Champion’ Victor Uscatescu earned a trophy for completing a record-breaking 133 nursing-initiated Order Sets for the month of August. The Nurse Clinician at the JGH Emergency Department became an enthusiast of the application while working as an intake nurse.
‘Champion’ Victor Uscatescu earned a trophy for completing a record-breaking 133 nursing-initiated Order Sets for the month of August. The Nurse Clinician at the JGH Emergency Department became an enthusiast of the application while working as an intake nurse.

We tend to think of a champion and a winner as being the same person—and in most cases, they are. But when it comes to Patient Order Sets, the champions on staff are at the forefront in preparing these patient care instructions, while the winners are the patients themselves.

To each champion goes a reward, once a month, for playing a key role in adding to the digital database of the Patient Order Sets. To the winners go the benefits of faster, safer care.

“Active engagement from our multidisciplinary teams in the POS initiative is essential in providing quality and safe treatment for our patients,” says JGH Nurse Clinician Christiane Honeine, who as the project’s Clinical Lead is often on hand to present awards to champions. Emergency nurses heeded the call, when the project expanded to their department in spring 2017.

Where the digitized database was previously accessed exclusively by doctors and residents, the ED nursing team identified the potential for the Patient Order Set system to help speed up and improve their delivery of care. So they took the initiative of compiling a discipline-specific database based on the most common symptoms of patients who visit the ED, such as abdominal pain or shortness of breath. If the corresponding order prescribes a specific blood test, or imaging, or the insertion of an IV, the nurse is now authorized to carry out that step, so that once the physician arrives to assess the patient, testing or treatment is already underway.

“Every minute counts for our shift to go well, so we think about those things,” says Victor Uscatescu, a Nurse Clinician at the JGH ED who values the efficiency and convenience of the application. “When we’re working as intake nurses, for instance, we see high numbers of patients. This new approach saves valuable time, and may even lead to a patient discharged sooner. This is the advantage.”

Well over 7,000 submissions have been recorded since the project was launched in Surgical Services in fall 2015 via a log that tracks the Patient Order Sets that are completed. Statistics are tabulated, enabling the project’s leads to identify frequent users, and reward the monthly champions.

Despite these incentives, new methods are not always readily embraced. Mr. Uscatescu concedes that it took him a little time to warm up to the new system. “Change is hard, but I gave the order sets a try and started to use them regularly in the RAZ, which has a favourable layout of equipment, with a computer and printer all within easy reach,” he explains. “I found that I got more proficient with practice. In time I came to like using the database. It becomes the new norm, and now I train all of the new nurses on it.”

Vascular team embraces database

Dr. Daniel Obrand, JGH Chief of Vascular Services, has promoted the use of the electronic forms among his residents, who have consistently logged the highest number of Patient Order Set submissions for each month in 2017. Here, residents (from left) Alen Antoun, Aly Ghoneim and Cora Fogaing enjoy a complimentary pizza lunch with Dr. Obrand, representing several of the team’s ‘champions’ of the project.
Dr. Daniel Obrand, JGH Chief of Vascular Services, has promoted the use of the electronic forms among his residents, who have consistently logged the highest number of Patient Order Set submissions for each month in 2017. Here, residents (from left) Alen Antoun, Aly Ghoneim and Cora Fogaing enjoy a complimentary pizza lunch with Dr. Obrand, representing several of the team’s ‘champions’ of the project.

Physicians apply their insights and specialized knowledge to the Patient Order Sets, modifying the original, standardized instructions provided by the database to conform to the practices and procedures that best reflect the medical needs of their patient population. This input refines the Patient Order Sets, increasing their usefulness to the doctors, nurses and healthcare professionals who carry them out.

 

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