ABSTRACT
BACKGROUND: Managing prescription renewal requests is a labor-intensive challenge in ambulatory care. In 2009, Vanderbilt University Medical Center developed clinic-specific standing prescription renewal orders that allowed nurses, under specific conditions, to authorize renewal requests. Formulary and authorization changes made maintaining these documents very challenging. OBJECTIVE: This article aims to review, standardize, and restructure legacy standing prescription renewal orders into a modular, scalable, and easier to manage format for conversion and use in a new electronic health record (EHR). METHODS: We created an enterprise-wide renewal domain model using modular subgroups within the main institutional standing renewal order policy by extracting metadata, medication group names, medication ingredient names, and renewal criteria from approved legacy standing renewal orders. Instance-based matching compared medication groups in a pairwise manner to calculate a similarity score between medication groups. We grouped and standardized medication groups with high similarity by mapping them to medication classes from a medication terminology vendor and filtering them by intended route (e.g., oral, subcutaneous, inhalation). After standardizing the renewal criteria to a short list of reusable criteria, the Pharmacy and Therapeutics (P&T) committee reviewed and approved candidate medication groups and corresponding renewal criteria. RESULTS: Seventy-eight legacy standing prescription renewal orders covered 135 clinics (some applied to multiple clinics). Several standing orders were perfectly congruent, listing identical medications for renewal. We consolidated 870 distinct medication classes to 164 subgroups and assigned renewal criteria. We consolidated 379 distinct legacy renewal criteria to 21 criteria. After approval by the P&T committee, we built subgroups in a structured and consistent format in the new EHR, where they facilitated chart review and standing order adherence by nurses. Additionally, clinicians could search an autogenerated document of the standing order content from the EHR data warehouse. CONCLUSION: We describe a methodology for standardizing and scaling standing prescription renewal orders at an enterprise level while transitioning to a new EHR.
Subject(s)
Drug Prescriptions , Standing Orders , Electronic Health Records , Reference Standards , Standing Orders/standardsABSTRACT
Introducción: La prescripción de cuidados básicos con temporalidad en unidades de hospitalización médico-quirúrgicas representa una laguna en los planes de cuidados y los estudiantes de enfermería no pueden adquirir la competencia de gestionar cuidados básicos. El objetivo de este estudio es validar un plan de cuidados estandarizado para prescribir cuidados que pueda ser utilizado por estudiantes de enfermería durante la adquisición de las competencias relacionadas con cuidados básicos. Método: Se llevó a cabo un estudio cuali-cuantitativo con paneles de expertos combinando las técnicas grupo nominal (generar la hipótesis de trabajo y desarrollo del método de prescripción), Delphi modificado (validez de contenido) y grupo focal como técnica complementaria para alcanzar consenso. El estudio se realizó durante un periodo de 18 meses entre 2013-2014. Resultados: Se han construido tres parrillas de prescripción de cuidados estandarizados utilizando la escala de Barthel que utilizan los estudiantes de enfermería de segundo curso de Grado en la Universidad Jaume I de Castellón, con soporte electrónico. Conclusiones: En la revisión de la literatura no se han identificado trabajos que especifiquen como llevar a cabo estudios de validez de planes de cuidados estandarizados. En este estudio se utilizó una combinación de métodos similar a la utilizada por otros autores para el desarrollo de diferentes herramientas. Con este sistema de registro y prescripción se puede evaluar la calidad de los cuidados y potenciar el rol responsable de enfermería en unidades médico-quirúrgicas
Introduction: The prescription of basic care with temporality in medical-surgical hospitalization units represents a gap in the care plans and nursing students cannot acquire the competence of managing basic care. The objective of this study is to validate a standardized care plan to prescribe care that can be used by nursing students during the acquisition of skills related to basic care. Methods: A qualitative and quantitative study was carried out, including panels of experts combining nominal group techniques (generating hypothesis of the research and the development of prescription method) with Delphi method modified (content validity) and a focus group as a complementary method in order to reach consensus. The study was carried out over a 18-month time period between 2013-2014.Results:Three levels prescribing standardized cares have been created. This has been made by using Barthel scale which is used in an electronic form by second-year nursing students at University Jaume I in Castellón. Conclusions: Studies that specify how to carry out standardized validated studies of care plans have not been identified in literature review. In this study a combination of methods was used, similar to that which was used by other authors in order to develop different types of tools. With this registration and prescription system it is possible to evaluate the quality of cares and reinforce the role of nursing in hospital medical-surgical units
