What are Action Sets?
Action Sets are pre-defined, structured lists of the appropriate diagnostic and treatment orders and actions based on clinical evidence for a range of clinical conditions.
Can you explain all the different terms surrounding Action Sets?
The language of Action Sets varies by geographic market, to fit with existing phrases and terminology already in use in that market and aid understanding of the product. The following terms are commonly used when describing Action Sets:
- Order entry, order sets, computerized physician order entry (CPOE), Action Sets, care protocols
- Care plans, care pathways, integrated care pathways
- Care bundles
- Proforma, template, guidelines,
Terms are not inter-changeable some are broader than others or have slightly different meanings. The terms ‘order set’ and ‘CPOE’ are widely used in the US and Australia, whilst the ‘care’ terms are specific to the UK.
The BMJ Evidence Centre product, Action Sets is similar to the commonly used description for order sets or care protocols but the content has been developed by the BMJ Evidence Centre and draws on the trusted and rigorous evidence that has been developed and presented in their products Best Practice and Clinical Evidence.
How can Action Sets be used within a hospital setting?
Action Sets cover a range of clinical conditions across all phases of the patient journey from Admission through to Referrals & Discharge Planning. Once a condition has been provisionally diagnosed by the clinician, the Action Set will guide/support the clinician along the diagnostic and treatment path, ordering tests and managing co-morbidities. The Action Sets are grouped to cover the end-to-end patient journey across all care venues during a hospital stay or outpatient management. It is available in a paper-based format or electronically to integrate into your existing systems depending on the format that works best for your hospital.
When are Action Sets particularly useful?
Action Sets support clinicians with diagnosis so they can be accessed by symptom or by condition. The Action Set content links to the EPR systems drug database, alerts, warnings and clinical rules. Thus when embedded within a clinical information system they enable the system to flag up any contraindications or drug interactions, and remove duplicate tests where more than one treatment path is being used. Each stage of care also includes referral to other disciplines, to remind the clinician which other teams need to be involved in the patient’s care.
How do Action Sets incorporate the latest evidence?
Hyperlinks throughout the Action Set link to the latest relevant evidence, which is presented in an evidence summary. These are based on the last 5 years of best available evidence-based medical knowledge and guidelines and are updated annually.
Our unique evidence summaries isolate the evidence specific to the request in hand and provide the most recently available guidance to support the inclusion of the request in the Action Set. They link directly to more in-depth information from BMJ Evidence Centre web tools, Best Practice and Clinical Evidence. They include GRADE statements, essential information about the condition, differential diagnoses, step-by-step treatment guidance, follow-up recommendations, patient leaflets, performance measures and links to national and international guidelines.
How do you customise and localise Action Sets?
At a hospital level: The BMJ team will support your hospital’s HIT and clinical teams to customise the Action Sets to your local environment. We’ll also recommend where you can include links to guidelines or policies, contact details or reference codes and other useful logistical information. You will have full control over which protocols are released to your clinicians.
At a patient record level: The BMJ Evidence Centre team identifies default options to be built into your EPR system that indicate whether orders should be pre-selected as mandatory or optional in accordance with best practice and to save time. The EPR system should allow these options to be deselected, or others added according to clinical judgment and the current patient context.
What conditions does Action Sets cover?
A list of conditions covered in your region are available from the BMJ Evidence Centre. Contact email@example.com to receive a copy.
How are Action Sets better than our standard care practices?
The BMJ Evidence Centre team provides the most recent evidence-based guidance in a format which is synthesised and peer-reviewed and focused on point of care use supporting patient care. Most hospitals are not able to individually provide this function due to the high cost and time-intensive nature of this work. .. The evidence-based content is then delivered within the clinician’s workflow so that he or she can access the latest evidence or guidelines that will help them make an informed decision for their patient at the appropriate time. It includes guidance on diagnostic tests (in order of priority) medication and other interventions, nursing orders and referrals and discharge planning. It also links to the EPR systems alerts and reminders e.g. allergy alerts or critical lab notification and helps clinicians to reduce omissions and duplication of effort. Action Sets also help you to evaluate your hospital’s performance and drive measurable benefits; as the date will feed through to the EPR systems reporting mechanism and enable graphs and data dashboards to be automatically generated.
What is Action Sets implementation and why is it needed?
Action Sets are designed to help healthcare organisations to measurably improve local clinical practice including service quality, efficiency and patient safety. This is a challenging task, which requires local clinical engagement, executive and resource commitment as well as change management. Action Sets are often a component of wider local service improvement programmes and their introduction needs to be co-ordinated with other local activities including deployments of other electronic systems such as Electronic Patient Record (EPR) or Computerised Physician Order Entry (CPOE).
Worldwide experience and research suggests that it is not enough to simply ‘make evidence-base content available’ to improve service. In order to make a positive impact, evidence-based content needs to be consistently used by local clinicians as part of their workflow. In addition, consistent performance tracking is needed to monitor and analyse any impact on service quality.
Most healthcare organisations require support to achieve this. The BMJ Evidence Centre recognises this challenge; we work with our customers to provide tailored support and tools to help them with Action Sets localisation, integration, clinical engagement as well as performance tracking.
What is Action Sets localisation?
The BMJ Evidence Centre creates master Action Sets based on available international evidence. Locally, master Action Sets need to be reviewed and customised by clinicians to ensure that they are consistent with local formularies, experience and workflows.
Localisation creates a sense of local ownership which is important for clinical engagement and ensuring sustained Action Sets usage as part of clinical practice.
Action Sets localisation involves creating local clinical teams for content review and building clinical consensus around particular local content (e.g. orders, recommendations)
The BMJ Evidence Centre provides a methodology, tools and tailored support to help local clinicians with this process.
What is clinical governance and why is it important?
Action Sets provide actionable protocols, which are designed to facilitate clinical decisions at the point of care. Hence, their content needs to be owned by senior departmental specialists, fully reviewed by hospital stakeholders and signed off. A local clinical governance structure needs to be created and robust Action Sets ownership assigned to ensure that local Action Sets are a reliable source of truth for local clinicians at all times.
The BMJ Evidence Centre provides a clinical governance methodology and tailored support to help our customers with this task.
Why do Action Sets need to be incorporated into the local clinical workflow?
It has been well documented that clinicians will oppose any ‘innovation’, which may hinder or slow down their workflow. As we want Action Sets to be used at the point of care to drive service improvement, we need to ensure they are embedded into and actually facilitate local clinical workflows.
This may be achieved by integrating Action Sets into local EPR systems (where available) or non-electronic (paper-based) workflows.
The BMJ Evidence Centre supports our customers, local clinicians and EPR partners to smoothly incorporate localised Action Sets into the local workflows and make them clinician-friendly to facilitate Action Sets usage as part of local practice.