Registed Nurses' Association of Ontario

Nursing Order Sets

What are nursing order sets?

RNAO’s nursing order sets are an unprecedented, innovative addition to the BPG Implementation Toolkit. Nursing order sets make it easier to translate evidence into nursing practice by providing clear, concise, actionable evidence-based intervention statements that can be readily incorporated into various practice settings. For example, Practice Recommendation 2.0 in the Smoking Cessation BPG states:

" Nurses introduce intensive smoking cessation intervention (more than 10 minutes duration) when their knowledge and time enables them to engage in more intensive counseling".

The lack of specificity in this recommendation poses a challenge for individuals/organizations wanting to implement this BPG. The corresponding nursing order set remedies this situation by providing a list of interventions that clearly define what is intended by the phrase "intensive smoking cessation intervention”. A subset of this nursing order set is provided below:

Why nursing orders are sets important?

RNAO's nursing order sets are important for several reasons. First, they aim to transform nursing practice by leveraging technology to promote knowledge translation and evidence-based decision making. Second, the order sets incorporate intervention statements that are based on international terminology standards, specifically: International Classification for Nursing Practice (ICNP) and Systematized Nomenclature for Medical and Clinical Terms (SNOWMED-CT). ICNP is uniquely developed by nurses to describe the work that nurses do using a consistent approach. The use of international terminology standards will also pave the way for standardization of nursing practice to facilitate comparative analysis of nursing data across health care sectors and geographical locations. In addition, with the advent of the electronic health and medical records, terminology standards will facilitate access and exchange of patient information in a standardized manner. Third, nursing order sets will make the nurses’ contribution to patient outcomes more visible to the interprofessional team. Finally, RNAO’s nursing order sets will facilitate the evaluation of BPG implementations by providing a mechanism to link specific evidence-based interventions to clinical outcome indicators. A case in point is the linkage that currently exists between the order sets and the indicators in the RNAO NQuIRE® database.

How might nursing order sets be used?

RNAO’s nursing order sets are designed to be incorporated into an electronic health or medical record, but they may also be used in a paper-based or hybrid order-entry system. The RNAO has partnered with PatientOrderSet.com to facilitate this process. For health care organizations this will translate into significant time and cost savings benefits. The first twenty-seven nursing order sets were released in August 2012 to complement the fifteen most commonly implemented clinical BPGs. Order sets will be developed for the remaining clinical BPGs and disseminated periodically throughout 2012-2013. Health care organizations across the spectrum of care including acute care, home care, long-term care and community care will derive many benefits from implementing these nursing order sets.

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