Process for order set management

You’re in charge of the process for order set management at a large teaching institution. You have 500 order sets that need to be reviewed. Assume your order set design takes into account evidence based medicine or clinical practice guidelines. Design a process so that your order sets are reviewed every two years. Start by thinking about what groups of practitioners need to be involved. How frequently would you meet? What is the review process for proposed changes? Please try to add as much detail around your process as possible. Your institution has the ability to provide utilization data on your order sets. Consider how you would manage zero or low volume order set utilization over the past year? Examples of low volume order sets that you find. Dr. Smith’s Total Knee Order set –provider based(named) order set but still follows practice guidelines Sepsis Order set-based on sepsis guidelines CABG pre-op order set-pre-operative order set based on surgical practice guidelines Would you just remove the order set or is there more information needed to make a decision. Are there any practice, workflow, or training considerations? What is the impact if these order sets go unused? Also you notice in your review some providers have created their own order sets outside of evidence based practice. Would you allow this? If the provider makes a clinical argument with data based on new outcomes would that suffice? What are your thoughts on managing the behavior moving forward?

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