Lab Order Sets
Traditionally, an inpatient medical record contains handwritten physician orders that are a mix of transcribed orders (e.g. a doctor telephones a nurse to request lab tests), free text orders written in a stream of consciousness style, and printed forms with orders for certain situations or care plans.
Should the laboratory design preprinted order sets for lab testing?
Essentially, that’s an outpatient requisition, but I’m talking inpatient. Heparin infusion, cardiac treatment, and transfusion are a few examples of common order sets that already include lab testing.
But we can and should do more. It can help standardize testing, eliminate much of the guesswork for ward clerks, and ease a transition into computer physician order entry (CPOE) for hospitals not already doing it. We have a logical role in designing and reviewing these orders as terminology or protocols change. The more we do, the more we are seen as a resource.
For example, an order set can be created for body fluid testing that includes pre-checked items such as cell count and differential, glucose, total protein, and culture. The form can contain instructions on collection, location of kits, and reminders to telephone the laboratory for assistance. A body fluid order set can be one page for all common types, for example, listed with most to least commonly collected.
The lab should be on the front lines, working with hospitalists, ED directors, nurses, and ward clerks to make sure the format works for everyone. (Don't leave it to a committee!) Being visible is the surest way to avoid being dismissed as invisible.
And it needn’t stop there. Reviewing physician chart orders, paper or electronic, can be revealing. Body fluid orders are low-hanging fruit, but urine cultures, daily orders, and serial testing can also suggest ways to improve. This kind of QI also encompasses the pre- and post- bookends of our traditionally analytical approach to quality management. As Michael Scott on The Office would say, it’s a win-win-win.
NEXT: Contaminated Urines