Thursday, November 3, 2011

Performance Improvement Tip of the Day: Embed the Desired Practice into the Clinical Workflow

This document illustrates a very simple improvement principle - in order to ensure that the desired practice is undertaken, embed it within the clinical workflow.

In this example, ordering of DVT prophylaxis was embedded into the tool that clinicians used to admit all patients - the General Admission Order Set. Multiple prior iterations of a separate "DVT order sheet" were tried but failed, because it was "yet another document that clinicians had to remember to grab".

Once the desired practice was built into this order set, the resultant ordering of DVT prophylaxis improved considerably. The issue in this case was not that the clinicians were unaware of the need for DVT prophylaxis nor that they were resistant to the same, but simply that the appropriate reminder (AKA checklist) was not presented to them at the time when they were most likely to write this order. A simple reminder, including the most common orders for DVT prophylaxis, provided at the most clinically opportune time gave the clinicians the precise "decision support" they needed to ensure safe practice.

The DVT Prophylaxis section is highlighted here:

We also included "decision support" on the reverse-side of the paper-based orders so that staff had an immediate reference handy to support their decision-making:

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