Key Considerations for Effective Use of Order Sentences in Healthcare
Discover essential insights for optimizing the use of order sentences in healthcare settings. Learn about the definition of order sentences, system configurations, governance processes, and the mandate considerations associated with their implementation. Gain valuable tips to enhance efficiency and reduce risks in prescription ordering practices.
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Order Sentences What Do You Wish That You Had Known at the Start? www.england.nhs.uk
Order Sentences - Definition The combination of multiple prescription order components that can be selected collectively rather that needing to be singularly composed. For example, amoxicillin 500mg orally three times a day Does anyone have a screen shot that we could add in here please? www.england.nhs.uk
Another example of an order sentence with diluent and administration instructions all predefined www.england.nhs.uk
Its a balance. Too few Too many www.england.nhs.uk
What would you want to share from your experience of using sentences? Know your system configuration options and functionality Sentences may be available for different types of prescription e.g. inpatient versus outpatient. Ensure that you know how they are handled by the system and whether there is any overlap To reduce configuration effort and potential errors check to see whether order sentences are used for more than one prescription type e.g. TTO and outpatient. Some may be OK for one and not the other . Some systems allow the linking of order sentences, some do not Some allow a dose range whereas other do not www.england.nhs.uk
What would you want to share from your experience of using sentences? Governance Ensure that you have a governance process in place for the identification and management of sentences including safety checking. You may wish to use a standard reference source for example the BNF, for the core content and ensure that you have a governance process for any requests that sit outside of this Ensure that you have a change control process to manage ongoing updates Maintenance of sentences may better sit with the clinical team rather than the informatics team as they are more up to date with policy and practice good communication needed www.england.nhs.uk
What would you want to share from your experience of using sentences? Should you mandate order sentences? You may have an option that circumvents the use of order sentences; it is worth ensuring that training highlights that this might be less helpful to prescribers (Review if it is possible to configure the system to stop users from circumventing order sentences) Equally you may wish to mandate order sentences (or specific fields within order sentences (e.g. dose form, unit of measure) in certain circumstances depending on local configuration options and limitations Mandation may be used to help reduce risk for example for high risk medicines in particular methotrexate weekly schedules www.england.nhs.uk
What would you want to share from your experience of using sentences? Display Issues Think about the order of display if configuration allows put the high use options at the top of the list i.e. what is clinically most useful to present first. Users tend to pick the first one .. Paediatrics separate out adult and paediatric orders if possible to reduce the risk of mis-selection. Check what local configuration will allow separate window, filtering on age Specialty specific order sentences may be helpfully filtered or only displayed to certain users depending on configuration. For example critical care sentences etc. Do not build too many sentences thus requiring the users to scroll to find them they may not bother .just gives you extra work Review if better to group order sentences in an order set/care plan for certain drugs www.england.nhs.uk
What would you want to share from your experience of using sentences? Should non-prescription information be included? Remember to focus on both prescription AND administration as ability to support both may be available Use text or labels to guide users to make the right selection for example a header to identify that an order sentence may be limited to one specialty If you want to provide more information around specific parts of a sentence for example administration guidance, ensure that the instructions are sufficiently generic whilst remaining helpful. If the sentence is altered by the prescriber very specific guidance may be rendered erroneous Do not provide excessive additional information/instructions as it may not be read or it could be truncated www.england.nhs.uk
What are the upsides of using sentences - 1? Supports standardisation and encourages users to prescribe appropriately Reduces mis-selection risk as only one selection required Can include additional instructions e.g. administration instructions Establishes a minimum data set for an order improving the quality of prescribing For example - can mandate and include a diluent for IVs Can mandate indication and review for antibiotics www.england.nhs.uk
What are the upsides of using sentences 2? Quicker so clinicians will use preferably Helps with clinical engagement particularly if users can see changes suggested have been accepted Can use a dose calculator to reduce risk of errors (assuming system allows) Can maintain and change things quickly to facilitate supply issues, formulary alterations, alerts etc www.england.nhs.uk
What are the downsides of using sentences -1? Maintenance can be resource intensive need a balance of enough but not too many Clinicians get lazy by just picking the first one If no order sentence for dose required clinicians will often just pick and not change Some medicines are hard to provide a sentence for due to a wide range of doses e.g. morphine Frequencies may be associated with a time and prescribers do not always appreciate what the fields do and how they work. For example stat may be too close to a routine dose or stat may be missed Need ensure that pick clinically relevant sentences rather than just list every potential one www.england.nhs.uk
What are the downsides of using sentences -2? System behaviour may add complexity to sentence definition for example where different sentences required for prescriptions type e.g. inpatient vs outpatient Non-mandatory fields in order sentences may be ignored by prescribers i.e. they will often do the bare minimum balance required between supporting, guiding and being too proscriptive You can only put so much info in a sentence before it becomes unwieldy and difficult to read may lead to error What is the optimum number of sentences to present users unlikely to scroll past the first few. Probably best to base on what user will see without having to scroll e.g. around 8-10 sentences or fewer Less flexible for prescribers care needed not to mandate items in which flexibility definitely required www.england.nhs.uk
Are there any shortcuts that could be helpful? Share current sentences but may need to understand the context. Should not use without local governance validating Wirral order sentence catalogue Share list of components e.g. frequencies etc. Share governance process change control process www.england.nhs.uk
What else should you know? Running a report on what is used may help with maximising impact allowing little or unused sentences to be removed Deployment of multiple select routes of administration may not generate the benefits expected introduced a long time after implementation may have user related change issue Multiple routes may also negatively impact on closed loop prescribing you should check up front Need to continually revisit and update to keep pace with policy and practice particularly a challenge if lots of additional information included www.england.nhs.uk
What are the alternatives.. Could use a blank slate for all prescriptions but will not deliver against risk reduction benefits of ePrescribing & clinicians likely to buy-out as takes longer Order sets are predicated on using order sentences provide some flexibility to display or hide specific sentences that you may want to explore www.england.nhs.uk
Contributors Andrew Heed, Newcastle Brian Power, Wirral Nilpa Hansrani, Imperial Version 2.0 October 2017 www.england.nhs.uk
