Ordering is an activity of healthcare prescribers whereby tasks are identified, allocated and timed so that investigations, medications and other interventions support patient care goals. All orders have a request component and an action component.
The Connect Care clinical information system (CIS) enables ordering of all medications, procedures, investigations and interventions available anywhere in Alberta. Understandably, orderable items may be subject to local restrictions, availability or other constraints. For the most part, the CIS is able to help with default values that are aware of the current context. Even so, orders can have great impact and therefore deserve attention to detail. The good news is that once context-sensitive details have been specified, the configured order can be saved as a personal preference with all typical settings pre-filled. Personalizing orders is one of the best ways to speed Connect Care workflows.
A variety of circumstances can make inpatient ordering more complicated. Urgent transfers – to or from emergency, critical care, operating room, dialysis, inpatient and reactivation services – can contribute to order litter in the form of duplicate, orphaned (not associated with a phase of care) or inactive orders that have not been cleared by prescribers on either side of a care context shift. Stray orders can make it harder to recognize and manage important orders. They can also bloat summative documents, such as transfer reports, that automatically pull in order lists.
Periodic “deOrderizing” should be done to find and remove inappropriate, unnecessary or misleading strays. Prescribers may be asked to do this by other healthcare team members who struggle to manage patients’ orders. Tips describe activity-based processes that can restore order to orders:
Diagnostic Imaging Orders
DI orders can present unique challenges. Clinical decision supports (appropriateness guides) may be embedded. Outpatient orders must also be mindful of whether the investigation is expected at an AHS facility (on Connect Care) or an independent DI provider.