The multidisciplinary Pain Management Committee at Methodist Hospitals (Northwest Indiana) includes representatives from pharmacy, nursing education, quality, IT and clinical informatics.
Methodist Hospitals rarely puts any opioids on a post-op order set. In most cases, physicians must go outside the order set if they want to prescribe a narcotic. According to Rhonda Planck, RN, BSN, CNRN, “We’ve left controlled substances on a few order sets because the physicians really pushed for it. However, when it comes to opioids, they cannot order a refill and can only write the prescription for a maximum of seven days. We are really trying to get away from making opioids a default option. Every patient’s pain level is different, and it is important to be able to take that into consideration.”
Methodist Hospitals runs their order sets through a third-party vendor to keep up-to-date with evidence-based content. According to Planck, “We run a report to extract the order sets out of our EHR and then import them into the third-party system. It looks at our order sets compared to evidence-based and helps us determine what might be missing.” Order Sets must be evidence based with hyperlinks out to the supporting evidence.
There is a clearly defined process at Methodist Hospitals for updating and reviewing any order sets that include opioids – involving a wide range of stakeholders, such as representatives from pharmacy, nursing, nursing education and quality. Order sets are grouped by specialty, and the division chief over each specialty is ultimately in charge of providing final sign-off. Approval from the Methodist Hospitals and Medical Council is then required before implementing any order set into production.
Notably, the order set review process is completely electronic. According to Planck, “Each reviewer – usually starting with our pharmacist – receives an email with a link that takes them to the third-party system. They can review the order set, make comments and mark it as ‘complete.’ The system then notifies us, and we can assign the order set to the next group of reviewers.” Planck notes that the fact that stakeholders can work on – and approve – order sets electronically has been key. “We don’t have to call a meeting to get everyone in the same room every time we want to update or review an order set,” says Planck. “People can do the work on their own time – which really helps streamline the process and makes everything much more efficient.”
“From a CIO viewpoint, I love it when interdepartmental committees form to utilize the EHR and other accenting applications to take on critical issues that impact the community we serve. Best practice knowledge and evidence-based solutions provide our clinicians with the data they need to make appropriate decisions for the care of our patients. Providing clinicians with the proper tools and data to address the opioid crisis is key to saving lives.”
Tim Diamond, CIO, Methodist Hospitals