Download CRC Technical Staff

Clinical Research Center
Optimization Initiative
Ideal Physician Order Sets
May 30, 2014
Lamar Bowman
and
Crystal Rice
Institutional financial pressure
CTSA NGA reduction
NCRR to NCATS
RFA changes (different
functions)
CRC
Optimization
Program income requirement
Space changes
CTRC expansion to ‘community
2
Optimization Committee
CRC Pre-Visit Workflow Activities
Snapshot
Pre-Visit Activities
VICTR
Resource
Request &
Approval
Approved Finance
Billing Plan
Study
Start-Up
Meeting
w/CRC
Orders should reflect
approved Finance
Billing Plan
Schedule
Request
by CRC
User
1) Patient visit specific order
set reflects approved Finance
Billing Plan; 2) Complete
StarPanel Research Reg.
Form
Patient
Arrives at
CRC
EPIC Check-In
by CRC Med. Rec.
- w/EPIC labels
Workflow Stages:
•Study Start-Up Meeting
with CRC
•Scheduling
Order Sets
• What’s New? Order sets for all inpatient and
outpatient visits requiring CRC nursing and lab support
will be needed at the time of CRC study-start meeting
and scheduling request
• Why? 1) Good Clinical Practice; 2) To confirm/perform
VICTR-approved services; 3) Improves Resource
Tracking Post-visit
• Value? 1) Patient Safety; 2) Reduce Protocol
Deviations; 3) Reduce VICTR Resource Request
Amendments; 4) Improve Data Quality
Ideal Order Set
• Inpatient and Outpatient studies need signed
physician order sets if requesting CRC Nursing
Support. These may be in the form of WIZ preorders or may be written orders.
– These orders will need to be signed by an MD with
Vanderbilt clinical privileges and electronically
generated, uploaded, faxed, or delivered at the
time of scheduling.
Ideal Order Set Cont.
• Provide contact information for PI, MD, and
study coordinators
– phone numbers, pagers, after hours numbers, and email
• Order sets should reflect specific study visit
needs
• Protocol study visit should match Billing Plan
Ex: Cycle 1, Day 1
• Order sets need to be updated when
amendments are made
Ideal Order Set Cont.
• Specify if patient will arrive consented or PI
needs to be notified to perform Informed
Consent. (Future: Star Panel Research Patient
Registration Form integration)
• Orders need to include protocol number,
patient name, date of birth, and medical
record number. De-identified studies may
need a subject number in lieu of medical
record number
• Allergies
Ideal Order Set Cont.
• Diet restrictions
– Example: Fasting for blood draw
– Specific diet needs should be discussed with
dietary department
• Vital signs
– Unit policy is once per shift
– Specify additional requirements such as
positioning, frequency, length of rest prior, O2Sat,
etc.
Ideal Order Set Cont.
• IV/Phlebotomy needs
– Specific details should include: location, size, &
EMLA for pediatric patients, etc…
• Provide D&H account numbers if needed such
as labs, medications, etc…
• Provide detailed processing Instructions such
as centrifuge speed, time, aliquot volume,
storage location
Ideal Order Set Cont.
• Specify if tubes will be provided by study
personnel
– CRC provides 5 mL red top tube, 4 mL dark green
top tube, 3.5 mL light green top tube, 4ml, 2 mL
purple top tubes, 4.5 mL & 2.7ml blue top tubes,
red, green, & purple Microtainers for pediatrics
• Industry studies should include detailed
instructions for specific testing such as urine
dipstick or drug screen
Ideal Order Set Cont.
• Medications patient will be taking while on
CRC need to be listed
– Specify if study personnel will be responsible for
drug administration
• Medication list includes study drug or placebo,
home medications, PRN medications, and
drugs needed in the event of an adverse
reaction
Ideal Order Set Cont.
• Provide study specific medication parameters
• List procedures needed such as dexa, biopsies,
pregnancy testing, ECG’s, etc.
• Activity restrictions
– Example: Lying flat, resting prior to procedure, or
may be out on pass
• Discharge instructions
– Contact information, diet, medication, activity
level, & post procedure care
In Summary
• We will provide order set templates to guide
study development
• Need signed physician orders at time of
scheduling
• Include specific study visit billing plan in
orders
• Provide details in order for CRC nurses to
ensure quality data collection
CRC Access Center Team
Members
 CRC Nurse Manager & Assistant Manager
 Lana Howard, Deloris Lee
 CRC Nurses
 Shelia Beavers, Lamar Bowman, Samantha Saalwaechter, and Crystal Rice
 CRC Scheduling & Check-In Staff
 Carol Sisco, Annette Lantz, Connie Dotye, Shela Williams
 CRC Technical Staff
 JoAnn Gottlieb, Regina Tyree
 VICTR Operations
 Terri Edwards
 VICTR/SRC Administrative Staff
 Jennifer Adams, Stacy West