Implementing Adult Covid-19 Electronic Order Sets in a Children's Hospital

ABSTRACT

BACKGROUND AND AIM: An eight-bed adult COVID-19 critical care (CC) unit was established within our pediatric intensive care unit (PICU) when SARS-CoV-2 variants increased CC bed demand. Our objective was to rapidly roll out electronic order sets (OS) to facilitate computerized provider order entry (CPOE) for adult patients admitted within a children's hospital. METHOD(S) OS development began from the assessment of OS from seven adult CC units. Using a pre-existing PICU Admission template, we created two OS adult COVID-19 admission and on-going care. We tested the prototypes in a multidisciplinary onsite-virtual hybrid tabletop simulation to evaluate usability within established workflows. Participants utilized role-specific profiles within the electronic medical record (EMR) training environment which paralleled their computer interface, permitting charting and documentation. EMR analysts were present to gather change requests. Following implementation, we performed twice daily hot debriefs with end-users to further identify issues. RESULT(S) 16 multidisciplinary bedside providers participated in simulation testing of the prototypes. Two safety issues were addressed before implementation. The electronic OS were developed, tested, and implemented within 8 days. The post-implementation hot debriefs identified one medication addition, and no deletions were necessary. CONCLUSION(S) Caring for adult COVID-19 patients within a freestanding children's hospital presents challenges and has the potential to introduce latent safety threats. Rapid development and implementation of electronic OS within 8 days to facilitate CPOE and reduce healthcare provider cognitive burden relied on leveraging functionality within the EMR system, performing iterative testing with a tabletop simulation, integration into previously established workflows, and gathering post-implementation feedback for continuous improvement.