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From Epic: Regarding the signature of protocol orders

17 Feb 2019

Assigning protocols to the right provider

By: Christine Clarke, MD, MEC President; and Claire O’Brien, MD, CMIO

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You may have seen a recent CG article about protocol orders needing to be in place so they can be backed up. We wanted to emphasize another thoughtful decision made in this process: Which provider actually gets the order assigned for signature when an order is placed from that protocol? Historically, these orders were assigned to the provider who wrote the original protocol order.

As an example, one very common protocol order is “replace potassium per protocol.” When a provider writes this order, they have no idea whether it will need to be used for actual potassium replacement. This provider ends their shift. The replacement is done, generating an order with no available provider to sign. The originating provider then has orders ‘piling up’ in their absence, orders that they do not realize are assigned to them for signature. This has led to unexpected delinquencies.  

The Physician’s Informatics Council (PIC) weighed in as to how these orders are assigned. Unanimously, the PIC agreed that the actual orders generated by the protocol should be assigned to the attending at the time that order is written. This prevents protocol orders from clogging up the system when the provider who initiated the protocol is no longer on duty. It also provides information to the current attending that certain orders are being placed. This is good information an attending might not otherwise know, if not for the signature assignment. 

Recently, a few providers refused to sign protocol orders that they did not initiate, uncovering the need to clarify this process. This system is designed to protect you as a provider. 

It takes a team to make this work best, and please remember, you may discontinue any protocol with which you do not agree. But you cannot discontinue a protocol of which you are unaware.

We believe this will also add a layer of protection to the patient by bringing recently placed protocol orders into the attending’s line of sight.  Thank you for your time, understanding and support.