Systematic Update of Computerized Physician Order Entry Order Sets to Improve Quality of Care

A Case Study

Physician order sets require rigorous review and maintenance to ensure quality of care and safety.

Order Sets—groups of orders to manage a disease state or procedure—can contribute to the efficiency, safety, and quality of hospital computerized physician order entry (CPOE) systems and enhance clinical decision-making. Seattle Children’s Hospital started using CPOE and order sets in their clinical information system in 2006 on an ad hoc basis.

To help staff at the teaching hospital improve consistency, correct errors, and update clinical content to reflect current best practices, the Seattle Children's Hospital formed a Clinical Effectiveness team, engaging various hospital departments. They found that the order sets lacked clinical owners, leadership support to maintain them, and a formal review process. Staff created a new process to address these and other deficiencies, and documented the process with an order set standardization guide.

Over the course of the eight months of the project, 178 order sets went through the standardization process, 18 order sets were removed as obsolete, and 39 were delayed for standardization because related clinical guidelines were being updated. The project team continues to refine the iterative process.

The authors point out that it is not enough to have a CPOE system, but it must be maintained to assure that order sets in it conform to the latest evidence of effective patient care delivery and safety.

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