crafting safe, clear pre-printed orders · 2014-11-18 · crafting safe, clear pre-printed orders...

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Crafting safe, clear Pre-Printed OrdersBC Orthopaedic Collaborative

Janice MunroeFH Medication Safety CoordinatorSeptember 9, 2008

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Crafting safe, clear Pre-Printed Orders

BC Orthopaedic Collaborative

Valerie MacDonald FH CNS Ortho/ SurgeryJanice Munroe FH Medication Safety CoordinatorSeptember 9, 2008

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Implications for practice

DVT prophylaxisPain Management

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Lessons learned

KISS. It’s 0400 and I have a cold.

Balance flexible options with clarity.

Evidence emerges: Prepare to change.

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DVT Prophylaxis

DALTEPARIN 2500 units subcutaneously at ______ (6 hours Post-op from Admission to Recovery Room

DALTEPARIN 5000 units subcutaneously daily starting Post-op Day 1 x __________ days

Other _______________________________ When giving LMWH, wait 22 hours before removing an epidural or regional catheter. Do not give LMWH for 2 hours after removal.

Pneumatic calf compression devices to each leg to start in recovery room.

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Pain Management

ACETAMINOPHENCELECOXIB 200 mg po q 12 h post operative day 1 only then CELECOXIB 200 mg po OD x 2 days No Additional NSAIDSOXYCODONE 5-10 mg po q4h prn OXYCODONE SR 10 mg po q12h starting postoperative day 1x 3 days. May increase SR dose to 20 mg the next morning, if breakthrough dosing equals 20 mgs or more. Inform pharmacy if dose increased. Use only if patient is unable to tolerate oral analgesic:

HYDROmorphone sc Or IV

OTHER ___________________________

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Side effect management

N & VondansetrondimenhyDRINATEproCHLORperazine

PRURITUSdiphenhydrAMINE 25 mg PO or 25 mg IV q4h PRN

SLEEP ZOPLICONE. Or Use patient’s own hssedation.

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Constipation

LACTULOSE 10 g (15 mL) PO daily - hold if loose stools or diabeticSENNOSIDES 12 mg TAB - 2 TABS PO at bedtime (hold if bowel movement in last 24 hours)GLYCERIN suppository per rectum on post-op Day 3 PRNIf no BM after suppository, give SODIUM PHOSPHATES 130 mL enema per rectum. May repeat x 1

If no BM after enema, call physician

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Does this look familiar?

Legibly?Really?

Can you read this?

Where do you begin?

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How safe are Pre-Printed Orders?

Clarity – interpretation of handwriting

Accuracy – order setsEntryVerification

Protocols – support quality care, best practice

Speed – less time to write, enter & verifyKey principles need to be fulfilled

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What are these key principles?

ContentConsistent layoutClear numerals (trailing & leading zeros)Eliminate lines (decimal points)Consistent units (SI values, mg, Units etc)Tall Man lettering (if in use)Limit use of abbreviations (medication names & ISMP list)

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vinBLAStinevinCRIStine

cefoTAXimecefUROXime

clomiPHENEclomiPRAMINE

quinINEquinIDINE

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Protocols – support quality care, best practice

VTE PreventionComplex therapyHigh risk medications

Multimodal Pain ManagementComplex therapyHigh risk medications

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Fraser Health Pre-Printed Medication Order Guidelines

Developed by the FH Medication Safety Committee in 2007Site level approval processRegional approval process- underwayVersion control

Form ImprintForms on demandEliminates the “addressograph”!

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Best PracticeMedication Reconciliation

Peace Arch Hospital – FH Pilot siteProcessForms

Reconciliation on admissionEmergencySurgery – Pre-Admission Clinic

Completed day of surgery

History doubles as post-op orders

Surgeon’s therapeutic plan

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Med Rec & SurgeryThe odd couple?

Why is this a “natural” fit?Med rec involves collecting information regarding medication use PRIOR to admission to hospitalSurgeon may not be aware of the medications or familiar with how they are usedOmissions and unintentional dosage changes can occurComplete documentation (& ordering) of home medications decreases calls to surgeon

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Med Rec & SurgeryThe odd couple?

Pre-admission Clinic typically collects this medication information

Ideal environmentPatient can bring in medicationsFamily/caregiver may be present to assist

Surgical Daycare Opportunity to identify any changes since PACDocumentation of time of last dose

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Med Rec & SurgeryThe perfect couple!

Natural fitDocumentation of patient information

Needed prior to surgeryNeeded to provide safe care post-opEnsures medication consistency is maintained throughout hospital stay On discharge, patient returns to pre-admission medications (if still indicated)

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FH Next Steps

Med Rec will be incorporated into the FH Orthopaedic Improvement InitiativeBurnaby Hospital - first pilot site

September 2008

The remaining 10 FH sites - ??

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