Making a Diabetic Ketoacidosis Computerized Order Set User-Friendly

Clinicians in the Shock-Trauma Intensive Care Unit (STICU) at Intermountain Medical Center have spoken frustration about the current diabetic ketoacidosis (DKA) order set. Both providers and nurses are often confused by these orders. This confusion has lead to delayed order implementation likely resulting in slower resolution of DKA. The STICU is a teaching unit consisting of fellows, residents, interns, and students rotating through on a short term basis, which may be anywhere from one day to one month. Due to this structured turnover, these clinicians are unable to familiarize themselves with the multiple order sets, which inhibit them from always being an effective resource for the bedside nurse. Thus, the providers and nursing staff needed the order set revised and clarified to create greater efficiency and improve patient care in the setting of DKA. The current order set was recently expanded to the Intermountain Healthcare Corporation. The purpose of this project was to revise the DKA order set used in the STICU. Flowcharts were created addressing the most confusing components of the order set. In the near future, the developed flowcharts will be embedded within different sections of the order set for clarification of treatment processes. The flowcharts developed diagram fluid, electrolyte, and insulin therapy creating less confusion through the progression of DKA treatment. Content experts were consulted to provide feedback on the order set and flowchart throughout the revision and development processes. Four objectives were identified for this project. The first objective was revisions to the DKA order set used within Intermountain Healthcare. A copy of the current order set was obtained and reviewed with the medical director of STICU. Meetings were scheduled as needed to address the proposed changes. The second objective was the development of flowcharts using the revised order set. Computer support experts were consulted about the creation and usability of the flowcharts in an electronic format embedded into the order set. The third objective was the initial presentation of the revised order set and flowcharts to the STICU medical director. Subsequent presentations to other clinicians have been completed by multiple meetings addressing changes to the DKA order set and implementation of new flowcharts. Feedback has been and continues to be obtained through the use of a Likert-styled questionnaire. Informal feedback has also been welcomed. Approval for the changes is being obtained with the expectation that the revised order set will be available soon. The final objective was the submission of an abstract for a poster presentation at the Excellence in Trauma and Critical Care Conference this fall. This project was important for several reasons. A quality improvement problem was identified in the STICU. Treatment of DKA is fairly defined with specific treatment goals. Yet, there have been problems effectively treating DKA using the Intermountain Healthcare computerized order set. It is anticipated that a more effective order set will improve provider and nurse understanding regarding treatment of DKA in the STICU, ultimately improving patient care.