Orderset, Best Practice Advisory
disruptive
Participants noted the simplicity of finding and navigating the EPT EHR orderset. When asked “what went well with the EPT process in the ED,” a quarter indicated it was “easy to use.” Participants stated that the orderset was straightforward, well-designed, and easy to find in the EHR. The EPT-specific discharge instructions were also considered efficient and helped with patient education.Perspectives on BPAs were mixed but generally positive. Almost half of the participants suggested using a BPA when asked how to implement ED-based EPT. When asked, “how do you feel about a reminder BPA for EPT that pops up when you order empiric therapy,” there were 13 responses for “appreciate it as a reminder,” seven responses for “like,” and four responses for “don’t like.” Participants also stated that they support BPAs that are more “patient-centered” rather than intended for financial or medicolegal purposes.I think the BPA is the most streamlined way to do it; if there wasn’t a hard stop I may not have written the prescription in this circumstance; I know some people are against BPAs in general but I liked it. I think if we’re really trying to implement this, a hard-stop BPA is the best way to not miss these prescriptions. It is probably the most effective way. (Participant 18)Several participants had conflicted feelings toward a “hard-stop” BPA, stating that clinicians already encounter numerous BPAs, which can be disruptive to clinician workflow. Conversely, several stated they would support a “hard-stop” BPA since the intervention may be otherwise forgotten.I’m conflicted about it. I dislike BPAs probably because of how many we have. So, adding another one makes me cringe. But if there’s a way to do it at the time of discharge rather than during the encounter then I wouldn’t hate it. (Participant 17)Additional non-BPA-based suggestions for early adoption included encouraging attendings to remind residents to use EPT, involving the ED pharmacist more extensively in the EPT process, and having a “standing nursing order” to order EPT medications.