Worksheet 2-1: CIS* Inventory
Worksheet 4-1: Intervention Specification Form
Specification Form for Validation
Intervention Name:
1. Clinical objective:
• Improve Patient Outcomes as evidenced by:
o Reduce average length of stay
o Reduce incidence of infection rate
o Reduce additional interventions
o Reduce complications
o Adherence to evidence based medicine
o Reduce or eliminate unwarranted medications
2. Desired action:
• Utilize preformatted order set for use by surgeon
• Alert physician if chooses inappropriate antibiotic for surgery type
• Alert physician/nurse at ADC cart if inappropriate antibiotic dispensed
• Allow for reordering of appropriate antibiotic from choice list
• Report compliance
3. Baseline performance:
Currently takes 1 FTE to report SCIP
| | | | | |Current Compliance |Desired Compliance |
|Anesthesia |Administers ABX w/in 1 hour of | | |
| |surgical incision -all cases |80% |100% |
| | | | | | | |
|Surgeons |Prophylactic ABX Selection |80% |100% |
| |Cardiac |(CABG + Other) | |80% |100% |
| |Vascular | | |80% |100% |
| |Ortho |(Hip + Knee) | |80% |100% |
| |Colon | | | |80% |
| |Colon | | |
|Physician |Clinical thought leader |Positive patient outcome |Reduce average length of stay by providing |
| | | |preoperative antibiotics by default. |
| | | |Reduce incidence of postoperative infection |
| | | |rate. |
| | | |Reduce incidence of additional surgical |
| | | |interventions related to postoperative |
| | | |infections |
|Patient |Recipient of care |Positive surgical outcome |Eliminate complications |
|Quality Group |Risk management |Positive patient outcomes |Adherence to evidence based practice |
| | | |Ensure physicians comply with best practices |
|Medication Safety Group |Hospital medication safety |Monitor and assure safe |Improve compliance with administration of |
| | |medication practice |antibiotics preoperatively |
| | | |Reduce or eliminate unwaranted medication |
| | | |administration |
| | | |Monitor & report adverse drug events |
| | | |Interface with P&T on best practice guidelines |
| | | |in regard to use of pre-op antibiotics |
|Nursing Management |Proponent & clinical thought |Ensuring compliance with |Assure all ordered meds are given |
| |leader |nursing rules & best practice |Assure all ordered meds are administered in a |
| | |guidelines |timely fashion |
| | | |Staff eduction Regarding pre-op antibiotic |
| | | |policy |
| | | |Patient education regarding pre-op antibiotic |
| | | |policy |
|Revenue Cycle Group | Budget owner |Ensuring efficient & effective |Monitor, by DRG, average length of stay compared|
|(length of stay) | |use of resources. Ensuring |to norm |
| | |reimbursement for provided |Monitor all outliers (case management) |
| | |services. |Report to leadership on financial status |
|Pharmacists |Fulfill and monitor orders, | |Monitor patient safety related to medications |
| |manage stock | |Educate on safe clinical practice related to |
| | | |meds |
| | | |Maintain appropriate inventory and stock on hand|
| | | |(including ADC) |
| | | |Monitor and control costs |
|Nurse | Clinical coordinator of care |Coordinate all aspects of |5 Rights (Patient, Drug, Dose, Time, Route) |
| | |patient care activity |Monitor labs (increasing white blood cell |
| | | |count?) |
| | | |Monitor vitals (fever, pulse rate, blood |
| | | |pressure, pain |
| | | |Look for signs of infection (redness, swelling) |
4. Clinical champion for this project:
• Director of surgery / anesthesia
• Med Exec (physicians that manage hospital)
• Pharmacy and Therapeutics
• Infection Control/Clinical Team
5. Urgency / required delivery time:
• Prior to 1/1/2010
6. Whose jobs do you expect to be affected by this project?
• Current FTE maintaining manual reporting / tracking will need to be retrained for new system.
• Ordering physicians/surgeons will need to be trained on the PFO and alert system (and evidence based guidelines).
• Pharmacists will need to be educated on project.
• Anesthesiologists and nurses who use the ADC cart
What are possible adverse consequences of implementing this project?
• Additional alert fatigue
• Slow down in current workflow
• System will result in decrease instead of increase in compliance
• Increase in costs
• Resistance to change
• Decrease in staff satisfaction
• Workflow issues with the nurse retrieving drug instead of physician (nurse can’t re-order)
Specification Form for Developers
|CDS Intervention Name | |
|Description: |Preformatted orders to increase compliance with SCIP |
|CIS application affected |CPOE |
|Intervention type |Orderset Modification |
|Workflow step |Ordering Medication |
|Specifically triggered by |Surgical Type |
|Presentation type |Orderset |
|What (information presented) |Antibiotic to Surgical Type matrix (see attached matrix for reference) |
|Alerting |Yes |
|Who (user) |Ordering Clinician |
|Action items |Alert for antibiotic outside algorithm, display PFO |
|Feedback channels and plan |Compliance reporting to infection control and risk management. Will bring to ordering |
| |physician as needed. |
|CDS Intervention Name | |
|Description: |Alert at Time of dispense from ADC |
|CIS application affected |EHR (Pharmacy) & CPOE & ADC |
|Intervention type |Alert |
|Workflow step |Dispensing Medication |
|Specifically triggered by |Surgical Type & Antibiotic Algorithm |
|Presentation type |Alert Box with Override Option |
|What (information presented) |Antibiotic to Surgical Type matrix (see attached matrix for reference) |
|Alerting |Yes |
|Who (user) |Clinician using ADC |
|Action items |Alert for antibiotic outside algorithm, suggested antibiotic presented in pick list. |
|Feedback channels and plan |Compliance reporting to infection control and risk management. Will bring to ordering |
| |physician as needed. |
|CDS Intervention Name | |
|Description: |SCIP Compliance Reporting |
|CIS application affected |EHR (Pharmacy) & CPOE & ADC |
|Intervention type |Automated Reporting |
|Workflow step |Data elements needed for measuring compliance gathered, aggregated and reported against |
|Specifically triggered by |Weekly, Monthly and on request |
|Presentation type |Standard report (charts, trends) |
|What (information presented) |Antibiotic to Surgical Type Compliance Metrics |
| |Time of drug administration vs surgical cut time |
|Alerting |No |
|Who (user) |Infection Control and Risk Management. Revenue management (TBD). |
|Action items |Intervention with physicians prescribing outside of guidelines. CMS compliance reporting.|
|Feedback channels and plan |Compliance reporting to infection control and risk management. Will bring to ordering |
| |physician as needed. |
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