Tiranun Rungvivatjarus, MD*1;Julia Beauchamp-Walters, MD2;Erin S Fisher, MD, MHM3;Stephanie Lawrence, BSN, RN2;Benjamin Brenners, MSN, RN, CNL, CPHON2 and Kyung Rhee, MD, MSc3, (1)University of California - San Diego, San Diego, CA, (2)Rady's Children Hospital, San Diego, CA, (3)University of California/Rady Children's, San Diego, CA

Meeting: Hospital Medicine 2017, May 1-4, 2017; Las Vegas, Nev.

Abstract number: 210

Categories: Innovations Abstracts, Quality Improvement

Keywords: , ,

Background:  Children and Young Adults with Special Healthcare Needs (CSCHN), especially those with multiple organ systems involvement, experience frequent and often lengthy hospitalizations. Hospital discharges for these children can be a complicated process that requires a deliberate, multistep approach and coordination among multi-disciplinary team members. Previous studies have demonstrated that homecare is a cost-effective measure compared to hospitalized care, saving up to $83,000/patient on ventilator-dependent children and reducing home chemotherapy costs by 17%. Rady Children’s Hospital San Diego (RCHSD) serves a continuingly growing population of medically complex patients and is responsible for over 3700 homecare orders annually. Due to the intricacies of medically complex patient management and the lack of resident training on homecare process, the rate of homecare order corrections has been as high as 50% for certain equipment. Incorrect homecare orders and frequent order revision affect quality of care by increasing fragmentation of the work day, distracting medical providers from other patient-related duties, delaying discharges, increasing risk of inducing added errors with each revision, and causing family distrusts in the medical team.

Purpose:  To optimize the RCHSD homecare order set so as to decrease medical errors, improve transition of care, and increase resident comfort with homecare orders. Our aim is to decrease homecare orders requiring revision by 25% over a 12-month period.

Description:  Plan-Do-Study-Act Cycles used: (P) 4/2015- 9/2015 -Multidisciplinary Team of Homecare Liaison, RN, Pharmacist, Resident, IT, and Hospitalist collected baseline data, identified order failures, trialed changes (order set), and identified barriers to implementing the changes. Changes included: pre-selected line flushes, pre-selected RN visit orders, and hard stops for G- and J-tube feeding regimen and supply details. (D)Revised homecare order set “Go live” 10/2015; ongoing resident training held monthly – bimonthly from 11/2015 – 5/2016 to capture rotating residents. (SA) Post-implementation data collected 1/2016 – 9/2016. Basic frequencies, proportion z-test are reported. Order revisions decreased from baseline 0.3/order set (N = 1675 orders) to 0.26/order set in the post intervention period (N = 2747 orders), p=0.005.  Total number of revisions decreased by 13%. When each subset category of homecare orders was analyzed, there was a statistically significant decrease in the proportion of duplicate order for the Gastrocare homecare (p = 0.021) and Vascular Access Device homecare order set (p = 0.009).

Conclusions:  Using PDSA with a multidisciplinary team to optimize the homecare order set reduced ordering errors, in particular for orders for high risk patients with GI and Cardiovascular needs. Pre-selected orders and using hard stop feature to obtain essential information for order completion addressed key failures identified by the team.

To cite this abstract:

Rungvivatjarus, T; Beauchamp-Walters, J; Fisher, ES; Lawrence, S; Brenners, B; Rhee, K . RADY’S HOMECARE ORDER SET: NO MORE GUESSES, NO MORE ERRORS! LET EMR WORK FOR YOU!. Abstract published at Hospital Medicine 2017, May 1-4, 2017; Las Vegas, Nev. Abstract 210. Journal of Hospital Medicine. 2017; 12 (suppl 2). https://www.shmabstracts.com/abstract/radys-homecare-order-set-no-more-guesses-no-more-errors-let-emr-work-for-you/. Accessed April 1, 2020.

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