ISMP releases Guidelines for Standard Order Sets
The Institute for Safe Medication Practices (ISMP) recently released its Guidelines for Standard Order Sets to help organizations ensure that the elements of safe order communication have been followed when designing paper-based or electronic order sets. Focused primarily on medication orders, the guidelines also cover general aspects related to the design, approval and maintenance of all standard order sets.
Well-designed standard order sets, electronically- or paper-based, have many potential benefits such as reducing the potential for medication errors through integrated safety alerts, according to ISMP, of Horsham, Pa. “However if the standard order sets are not carefully designed, reviewed and maintained to reflect best practices and ensure clear communication, they may actually contribute to errors,” ISMP stated.
Order sets, according to the guidelines, should provide prompts in a designated standard location (top of the form preferred) to gather and document patient information including prompts for patient allergies, metric measurements of patient height (cm) and weight (kg) and patient demographic information.
The content of medication orders should include drug name, metric dose/strength, frequency, route of administration, indication, drug administration precautions, specific drugs to discontinue during therapy and instructions to address known potential emergencies, according to the organization’s checklist.
According to ISMP, to maintain order sets, organizations should:
The guidelines also include specific criteria for IV/epidural solutions/medications, electrolytes and compounded products, doses that include fractional amounts, chemotherapy orders, analgesics, pediatric medications dosed according to weight, all medications dosed according to weight, medications intended for patient’s older than 65 years of age and paper-based preprinted order sets.
ISMP’s complete checklist to guide the design and evaluation of standard order sets before granting approval for use can be found on the nonprofit organization’s website.
Well-designed standard order sets, electronically- or paper-based, have many potential benefits such as reducing the potential for medication errors through integrated safety alerts, according to ISMP, of Horsham, Pa. “However if the standard order sets are not carefully designed, reviewed and maintained to reflect best practices and ensure clear communication, they may actually contribute to errors,” ISMP stated.
Order sets, according to the guidelines, should provide prompts in a designated standard location (top of the form preferred) to gather and document patient information including prompts for patient allergies, metric measurements of patient height (cm) and weight (kg) and patient demographic information.
The content of medication orders should include drug name, metric dose/strength, frequency, route of administration, indication, drug administration precautions, specific drugs to discontinue during therapy and instructions to address known potential emergencies, according to the organization’s checklist.
According to ISMP, to maintain order sets, organizations should:
- Schedule at least a biannual review of the order set to ensure that no more than two years have lapsed since last approval; some order sets may require more frequent evaluation and re-approval;
- Remove older version of the order set from use or access; provide or make accessible the newer version to all affected areas (ideally online); and
- Implement plan to communicate significant changes in the order set to all who will/could be using it regularly.
The guidelines also include specific criteria for IV/epidural solutions/medications, electrolytes and compounded products, doses that include fractional amounts, chemotherapy orders, analgesics, pediatric medications dosed according to weight, all medications dosed according to weight, medications intended for patient’s older than 65 years of age and paper-based preprinted order sets.
ISMP’s complete checklist to guide the design and evaluation of standard order sets before granting approval for use can be found on the nonprofit organization’s website.