Nursing order sets standardize care across sectors, geographical areas


For decades, the Registered Nurses’ Association of Ontario (RNAO) has been helping nurses provide the best care possible to their patients or clients. RNAO reviews the latest research evidence on nursing interventions that produce the highest quality health outcomes, and publishes this information in its best practice guidelines (BPG). Hundreds of health-care organizations – nationally and internationally – have implemented RNAO BPGs since they were first introduced in 1999. There are currently 48 BPGs; nine of which focus on healthy work environments, and 39 on clinical practice.

RNAO BPGs were originally designed to be used in environments with paper-based health-care records and clinical resources. Increasingly, however, hospitals and other health-care organizations are using computerized equipment to improve care. RNAO has kept pace with this new trend by developing ‘nursing order sets’ to help hospitals and other health-care organizations to more effectively foster a culture of evidence-based nursing practice.

Nursing order sets are BPGs that have been converted into specific, action-oriented nursing interventions that can be embedded within a clinical information system or paper-based tool. These order sets help to standardize the care provided for a specific patient or client condition, such as pressure ulcers or pain. They also make it easier for nurses to access the best evidence to inform their practice, whenever and wherever they need it.

Ontario’s North West Local Health Integrated Network (LHIN) is the first organization in Canada to implement RNAO’s nursing order sets in 12 hospitals within its jurisdiction. The initiative is funded by the Small, Rural, and Northern Hospitals Transformation Fund, introduced by Ontario’s Ministry of Health at the beginning of April 2013. A total of $20-million is available to help small and rural hospitals across the province improve the quality of care for patients in their communities.

Geographically, the North West LHIN covers the largest health region in the province. It serves the largest Aboriginal population by proportion. And it works proactively with health-care providers, communities and the public in northwestern Ontario to set health-care priorities. It also provides oversight for the integration and co-ordination of local health-care services to ensure that patients have access to the care they need, and clinicians have access to the information they need to provide high quality care.

Like the 12 hospitals involved in this initiative, other health-care organizations will derive many benefits from implementing nursing order sets, whether they focus on acute care, home care, long-term care or community care. For example, it takes approximately 17 years for research findings to become a routine part of a nurse’s day-to-day practice. By embedding RNAO’s evidence-based nursing order sets within clinical information systems and electronic medical records, nurses will immediately have access to the best available evidence at their fingertips, to inform their practice.

Nursing order sets use a consistent language, called the International Classification of Nursing Practice (ICNP®), to describe the care that nurses provide regardless of the setting. Using a consistent language like ICNP will standardize nursing practice, making it easier for researchers to study the effect of specific interventions on health outcomes, and to compare the results across health-care sectors and geographical areas. This information will be useful for both nurses and policy-makers.

RNAO has partnered with on this project, a leading provider of order sets in Canada with a client base of over 245 health-care organizations. There are two implementation options: TxConnect and EntryPoint. Both are web-based applications. TxConnect allows health-care organizations to adapt the nursing order sets to their clinical context and print them as needed for inclusion in a patient’s or client’s paper-based health record. EntryPoint allows organizations to complete the order sets electronically using a desktop computer or mobile tablet.

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