EP03.10 - Making the Most of Healthcare Conversations
e-Health ePoster Library. Martell T. Jun 7, 2016; 131585; EP03.10
Tracy Martell
Tracy Martell
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Purpose/Objectives: In British Columbia, the Ministry of Health has mandated that health authorities adopt the concept of Medical Orders for Scope of Treatment (MOST) as a mechanism for patients to inform the direction of their healthcare in collaboration with their healthcare team. MOST provides a standardized framework for conversations about advance care planning (ACP) and goals of care to determine medically appropriate treatment interventions. MOST have six designations which translate shared treatment decisions into actionable medical orders that provide direction on code status, critical care interventions and medical interventions. MOST clarifies the intent of treatment and helps minimize unnecessary or unwanted treatments and patient transfers by promoting clear communication between patients, families and healthcare teams. Methodology/Approach: Having embarked upon the development and implementation of a cross-continuum electronic health record, we designed electronic MOST orders and developed policies, education materials and an implementation plan using a collaborative interdisciplinary advisory group consisting of six physicians with varying backgrounds; nurses and others from Informatics, Learning Performance and Support, Professional Practice, Communications; and a representative from Clinical Standards and Benefits. An overarching organizational strategy was developed for implementation of the concept of MOST, which is a significant change from the former 'full code' or 'No CPR' statuses. Policies were developed to provide a framework for providers to ensure a current MOST order was available for all patient encounters. The electronic system and computerized provider order entry (CPOE) helped force this function by embedding the MOST order content in each admission order set within the organization. Educational considerations were multifaceted, in order to address that fact that all clinicians and providers were going to be impacted in sites using our Electronic Health Record system, places using disparate electronic systems and sites using paper records. Consideration was given to address the overarching philosophy of MOST being the result of conversations between patient and clinician/provider that will evolve as circumstances change over the patient's lifetime. Clinicians were taught how to use electronic tools to easily review updates on conversations about MOST status. Education requirements were identified to manage the flow of communication between providers and clinicians at each transition of care given that some care areas remained on paper and some were live in the electronic record. Challenges we faced included the huge cultural shift our organization went through adopting the philosophy of MOST as an ongoing conversation that needs to occur at each encounter with the healthcare system. The decision to roll out MOST in a ‘big bang' across the organization or in concert with the implementation of our electronic health record was a fundamental decision with risks and benefits to each option and ultimately helped shape our approach. Finding/Results: To share our approach to rolling out Medical Orders for Scope of Treatment, as well as feedback from coordinators and educators, and preliminary feedback from end users on the electronic processes that were developed. Conclusion/Implication/Recommendations: Sharing the learnings from implementing an electronic framework for Medical Orders for Scope of Treatment (MOST), a provincially mandated requirement. 140 Character Summary: Island Health's approach to rolling out electronic Medical Orders for Scope of Treatment (MOST) using a collaborative interdisciplinary advisory group.
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