Building Blocks => Order sets =>

Standard Order Sets 

General

Standard (Institutional) Order Sets are those that are hospital developed and approved by the appropriate governing body.

• Often these order sets are diagnosis or chief complain based.  They represent the organization’s interpretation of the best medical evidence.
• Delineating characteristics of endorsable variation (local antibiograms, local formularies, state requirements) will provide guidance to the design process.
• End users are encouraged (or mandated) to use these sets when ordering for patients with the specific diagnosis or condition for which the set was created.
• These order sets are available to all users with access to hospital’s ordering system who are seeing patients for the relevant diagnosis.
• An implementation should have standard order sets for at least 80% of the diagnosis or chief complaints seen in that organization.

Advantages

• Support standardized care which then creates a more predictable course of care for patients
• Potentially reduces errors due to inconsistency or ordering mistakes.
• Measuring outcomes related to changes in care is easier.
• Typically can reduce the formulary scope.
• Most systems support links to the evidence from within the order set at the point of care. 
• Standardized protocols, such as DVT prophylaxis, glucose management, ICU sedation, and stress ulcer prophylaxis may be linked to appropriate admission order sets

Concerns

• In order to accommodate all possible, acceptable choices within a particular diagnosis, order sets can get lengthy.
• The work effort to create agreement and standardization across the organization is significant.
• Within multi-hospital systems, it may not be possible to standardize the order sets and formularies
• Physician resistance to “cookie-cutter” medicine

Maintenance

• These orders sets must be reviewed at a regular interval, typically yearly.  There should be a process for ad hoc reviews of these order sets as well.  Typically these ad hoc reviews are prompted by changes to evidence based medical knowledge, changes to the organization’s formulary or potentially a change in quality reporting requirements.