Smart Orders with Embedded Logic Align Clinical Practice and Guidelines

Purpose:
The purpose was to standardize criteria according to evidence-based surface guidelines, reassess resource allocation, and build an electronic system guarantying criteria adherence through smart order development with embedded logic designed to guide clinicians to appropriate surface orders.

Significance:
Certain surgical procedures, wound characteristics and patient risk factors require greater pressure relief necessitating rental of specialty support surfaces to optimize clinical outcomes. Previously, surface rentals lacked clinical practice standardization and exceeded budgetary allowance.

Strategy and Implementation:
Criteria-based orders were implemented based on best practice guidelines for all surface rentals. Rental choices were limited to the five most appropriate and beneficial to our population. A specialty bed consult referral and order were built. All specialty bed orders required a wound care team consult. Ordering privileges were restricted to the Wound Care Team and operating room charge nurses. The order requires identification of specific clinical criteria. Completion of the order automatically leads to the optimal rental surface based on the patient information input by registered nurses. Only patients meeting the clinical criteria have therapeutic rental surfaces ordered. Electronic alerts are automatically generated to key stakeholders upon order entry and cancellation. Surgical flaps and grafts are assessed daily by the surgical teams. Patients' wounds and skin are reassessed twice weekly by the wound care nurse. Based on these reassessments, bed utilization is adjusted.

Evaluation:
Order analysis eliminates billing errors and monitors expenditure. Since inception, monthly expenditures have decreased from greater than $20,000.00 to less than $7,000.00 representing a 65% reduction in monthly expenditure. No increase in hospital acquired pressure ulcer prevalence has been noted.

Implications for Practice:
Specialty surfaces are one component of a comprehensive pressure ulcer prevention program and surgical, wound, skin management. Smart orders with embedded logic and electronic communication strategies guarantees best practice adherence, controls resource utilization and streamlines workflow.