Clinical Research Center Optimization Initiative

Ideal Physician Order Sets

May 30, 2014Lamar Bowman

and Crystal Rice

Institutional financial pressure

CTRC expansion to ‘community

NCRR to NCATS

RFA changes (different functions)

Program income requirement

Space changes

CTSA NGA reduction

2

Optimization Committee

CRC Pre-Visit Workflow Activities Snapshot

Approved Finance Billing Plan

Orders should reflect approved Finance Billing Plan

1) Patient visit specific order set reflects approved Finance Billing Plan; 2) Complete StarPanel Research Reg. Form

EPIC Check-In by CRC Med. Rec. - w/EPIC labels

Pre-Visit Activities

• What’s New? Order sets for all inpatient and outpatient visits requiring CRC nursing and lab support will be needed at the time of CRC study-start meeting and scheduling request

• Why? 1) Good Clinical Practice; 2) To confirm/perform VICTR-approved services; 3) Improves Resource Tracking Post-visit

• Value? 1) Patient Safety; 2) Reduce Protocol Deviations; 3) Reduce VICTR Resource Request Amendments; 4) Improve Data Quality

Order Sets

Workflow Stages: •Study Start-Up Meeting

with CRC•Scheduling

Ideal Order Set

• Inpatient and Outpatient studies need signed physician order sets if requesting CRC Nursing Support. These may be in the form of WIZ pre-orders or may be written orders. – These orders will need to be signed by an MD with

Vanderbilt clinical privileges and electronically generated, uploaded, faxed, or delivered at the time of scheduling.

Ideal Order Set Cont.

• Provide contact information for PI, MD, and study coordinators– phone numbers, pagers, after hours numbers, and email

• Order sets should reflect specific study visit needs

• Protocol study visit should match Billing Plan Ex: Cycle 1, Day 1

• Order sets need to be updated when amendments are made

Ideal Order Set Cont.• Specify if patient will arrive consented or PI

needs to be notified to perform Informed Consent. (Future: Star Panel Research Patient Registration Form integration)

• Orders need to include protocol number, patient name, date of birth, and medical record number. De-identified studies may need a subject number in lieu of medical record number

• Allergies

Ideal Order Set Cont.

• Diet restrictions– Example: Fasting for blood draw– Specific diet needs should be discussed with dietary

department

• Vital signs– Unit policy is once per shift – Specify additional requirements such as positioning,

frequency, length of rest prior, O2Sat, etc.

Ideal Order Set Cont.

• IV/Phlebotomy needs– Specific details should include: location, size, &

EMLA for pediatric patients, etc…

• Provide D&H account numbers if needed such as labs, medications, etc…

• Provide detailed processing Instructions such as centrifuge speed, time, aliquot volume, storage location

Ideal Order Set Cont.

• Specify if tubes will be provided by study personnel– CRC provides 5 mL red top tube, 4 mL dark green

top tube, 3.5 mL light green top tube, 4ml, 2 mL purple top tubes, 4.5 mL & 2.7ml blue top tubes, red, green, & purple Microtainers for pediatrics

• Industry studies should include detailed instructions for specific testing such as urine dipstick or drug screen

Ideal Order Set Cont.

• Medications patient will be taking while on CRC need to be listed– Specify if study personnel will be responsible for

drug administration

• Medication list includes study drug or placebo, home medications, PRN medications, and drugs needed in the event of an adverse reaction

Ideal Order Set Cont. • Provide study specific medication parameters• List procedures needed such as dexa, biopsies,

pregnancy testing, ECG’s, etc.• Activity restrictions

– Example: Lying flat, resting prior to procedure, or may be out on pass

• Discharge instructions– Contact information, diet, medication, activity

level, & post procedure care

In Summary

• We will provide order set templates to guide study development

• Need signed physician orders at time of scheduling

• Include specific study visit billing plan in orders• Provide details in order for CRC nurses to

ensure quality data collection

CRC Nurse Manager & Assistant Manager Lana Howard, Deloris Lee

CRC Nurses Shelia Beavers, Lamar Bowman, Samantha Saalwaechter, and Crystal Rice

CRC Scheduling & Check-In Staff Carol Sisco, Annette Lantz, Connie Dotye, Shela Williams

CRC Technical Staff JoAnn Gottlieb, Regina Tyree

VICTR Operations Terri Edwards

VICTR/SRC Administrative Staff Jennifer Adams, Stacy West

CRC Access Center Team Members