Download That’s Bad Form! - Olive View

That’s Bad Form!
Michael Ben-Aderet, Tim Cushing,
Derek Huang, Alvin Liu, John Sy, and
Summer Williams
Why?
•
•
•
•
•
Too many forms
Forms need to be updated
Incomplete forms
Too many medical errors
Nurses paging housestaff
about orders
• Housestaff unsure about
available options
Goals
• Simplify Forms
• Improve Patient
Safety and Care
• Improve Housestaff
Satisfaction
• Meet Government
Requirements
Plan
• Review all forms that housestaff use
• Highlight necessary ones that need to be
updated
• Tackle those that are used the most
Old
Cardiology
Form
(OV1399)
From 2007
CLINICAL
INFORMATION???
MEDICATIONS???
I‘M AN INTERN…HOW
THE HECK SHOULD I
KNOW WHAT TEST TO
ORDER???
Process
• Reviewed form with Cardiology Dept
• Came up with form specifications:
– Patient information
• Name
• Medications
• HISTORY
– Test information
• Cardiology WILL change test depending upon
clinical history and reason for exam
Form Cycle
Specifications
Implementation
Testing
Form Design
Review
To be smart?
• What is a smart form?
– A form that can be filled out online and/or printed
• Improve legibility
• Improve accuracy of information
Now,
that’s a
smart
form…
New
Cardiology
Form (2013)
Review of Cardiology Form
• Improved transfer of information to cardiology
department
• Enabled optimal testing to occur
• Reduce exposure to unnecessary testing
• No longer need old EKG form – especially as
outpatient, just ask clerk to enter into system
and patient should present OV card to
cardiology department
Medicine Admission Form (OV2428)
• Top 3 forms used by housestaff
• Consistently being reviewed and updated
• …but missing a lot
• A comparison of forms:
– OVMC – 3 pages
– Harbor – 6 pages
Specifications
• Each section of the form with different
specifications depending upon the
department involved… for example:
Clerks, Phlebotomy,
Laboratory
Medical Administration,
Patient Safety, JCHAO
Things we cannot change…
• Handwriting –
PLEASE WRITE
LEGIBLY
• Dosing errors –
PLEASE CHECK YOUR
RXs
• That the RNs will
STILL page you about
your patient…
Old Order Form
Basic Information – Section 1
• ICU Added – no longer a separate form
• Holdover box added – nurses know who to page
(especially for hospitalist holdovers)
• Admission location clear
• Level of care change indication
Diagnosis and Assessment - Section 2
• Specified Isolation
• What old chart???
• Don’t forget our neutropenic patients!
Physician Notification – Section 3
• What the heck is a SUPO Form? – JC requirement
• STANDARD VITALS!!! 
• Don’t forget to change them if needed!
Activity and Diet – Section 4
• Fluid restriction box
Consult and Treatment – Section 5
•
•
•
•
Occupational Therapy
IV therapy: continuous vs fixed amount
Respiratory therapy
Chlorhexidine baths for patients on chemotherapy or with
central venous catheters (CVCs) – for nursing
Labs/Test – Section 6
• More tests, especially for ICU
• No more STAT labs – abuse of STAT power
• Phlebotomy Information
VTE Prophylaxis – Section 7
• Meets all government requirements
• Don’t forget to select a contraindication!
Medication Reconciliation – Section 8
• Start, continue, stop?
• Don’t forget hold parameters and PRNs
• Home medications MUST be listed in H&P
Typical Olive View Patient…
Common Medications – Section 9
• All those and more!... Night float will thank you for that
Miralax!
• GI prophylaxis
• Prevent therapeutic duplication
• Those pesky nebs!
Insulin – Section 10
• Can’t help you there…
• But at least you don’t have to write “units”!
Pain medications – Section 11
•
•
•
•
The pen is mighty…but checkboxes are easier!
I didn’t know we had (insert pain med here)!
What is that dose of IV dilaudid again? 2 mg?!
Avoid therapeutic duplication problem
Code Status – Section 12
• Only Attendings can sign DNR/DNI orders
anyway…
New Order Form
Achievement Highlights
•
•
•
•
•
•
•
Eliminated ICU order form
Consistent vital signs for patient safety
Reduce use of STAT labs
Reduce therapeutic duplication
Encourage proper use of DVT and GI ppx
Eliminate confusion with med rec section
Brought in further commonly used
medications
Assessment of New Form
• Asked housestaff to fill out the old and new
forms from a mock case
• Timed themselves filling out both forms
• Answered 5 questions based on old and new
forms
Survey Results
Old
(n=5)
New
Average Time (minutes)
6.0
5.3
General Satisfaction
7.0
8.6
Error Prevention
7.8
9.0
Efficiency
7.0
8.4
Areas of Improvement
7.8
5.8
Committees
• Both forms approved by MRRC (Medical
Records Review Committee)
• Admission Form must go to P&T committee to
be approved (for medications) in early July
• Will uploaded to the intranet for housestaff to
use after P&T committee review
Ongoing activities…
• Radiology form update
• Nuclear Medicine form elimination
• Insulin Form update
Acknowledgments
•
•
•
•
•
•
•
•
Dr. Mark Richman
Dr. Mike Rotblatt
Dr. Leland Powell
Dr. Susan Stein
Dr. Katherine Yu
Dr. Dennis Yick
Dr. Nick Kamangar
Dr. Robin Waschner
•
•
•
•
•
•
•
•
Anna Ziouzina
Laura Sarff
Karla Nungaray
Joy Mata
Lori Smith
Alma Alvarez
Jan Love
Carlos Carranza
•
•
•
•
Clerks
Nurses
Respiratory Therapy
Housestaff