EMR Order Set Speeds Time to Antibiotic Treatment in Musculoskeletal Infections

The UNMC contingent at the 2019 Musculoskeletal Infection Society, from right to left: Nurse Practitioners Dan Cramer and Tiffany Kalin, Dr. Angela Hewlett (Orthopedic Infectious Diseases), Dr. Curtis Hartman (Orthopedic Surgery). Dr. Hewlett moderated a scientific abstract session and served as a panelist for a prosthetic joint infection clinical case presentation session.

Dr. Angela Hewlett spends her time at UNMC not only studying Ebola but also working to prevent and manage musculoskeletal infections.  In addition to publishing this year’s update on “What’s New in Musculoskeletal Infection,” she collaborated with orthopedic surgeons, trauma surgeons, and emergency physicians to design and implement a new order set in the UNMC electronic medical record system to streamline antibiotic initiation in the setting of fractures.  Previously, physicians would have to build an antibiotic regimen for each of their patients, frequently resulting in ID consultation to determine the appropriate medication and dose.  By constructing an order set in the EMR, the authors hypothesized that providing clear and easily accessible instructions would lead to faster initiation of appropriate antibiotics in the emergency department.

The order set contains guidelines for fracture classification and recommended antibiotic strategies based on contamination, patient allergies and condition, and bacterial colonization. There are also direct links for providers to request an ID consult.

The results of their performance improvement project, published in the Journal of the American Academy of Orthopaedic Surgeons, were powerful.  Patients whose physicians used the new order set were evaluated sooner and received antibiotics faster compared to those whose physicians did not use the order set.  The order set has been rolled out at all UNMC/Nebraska Medicine sites and is available in the supplemental resources in their paper.



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