Post-Op Order Sets Game

How I Practice Video Series 
Kasandra Scales, MD, MPH
Syracuse, NY

The nice thing about the electronic medical record is the standardization of how you do your orders, how you provide care to patients on the computer, your order sets, and reducing errors and being more efficient. The down side is that you lose some of your critical thinking and analytics when it comes to physically writing down your orders; being able to say for this particular individual patient, what are the things that I need to do to pay attention to her needs given her particular clinical situation.

What I like to do with the newer generation, i.e. the medical students and the new residents, particularly with the interns, is synthesizing that for them and bringing it back to the basics so that they don’t lose that critical thinking and analysis that goes into pressing send on the computer. How I go about doing that is to play a little game. A lot of times you’re very busy in your practices, you’re very busy once you leave the operating room going on to the next thing, and if you’re in an academic setting or in a community setting that works with medical students or residents, it’s very hard to kind of figure out how to fit them into your schedule. One of the things that I have found to be useful for them but also for [me], is to engage them into what [I’m] already doing and what [I’m] thinking about but not saying out loud. With that [I] do what’s called a post-op orders game.

How I go about doing this is I talk to the students after I’m done with the case and I say let’s play a little game. At first they are a little taken aback by it but usually they get pretty into it. I turn the computer away from it so they are not able to see the actual order set. Then I ask them the first question – what would you order for this patient that we’ve just done this case on. First the response usually is I would give them pain medication. So you say, okay great, what kind of pain medicine would you like to give this patient? So you walk through what are the different types of pain medication, what are the pros and cons of giving them pain medication or not, the root of the pain medication, whether it be IV or PO, and how long you want to give them that combination of pain medication prior to sending them home. Another example would be, you could say what else would you order for them and they can say I’d give them fluids. Great, what kind of fluids would you give them, what’s the rate that you would give the fluids, let’s say for example she has congestive heart failure, how would you adjust the fluid rate with that person versus someone who is a 22 year old very healthy patient.

We do have order sets for a reason because it makes us more efficient; however you do need to adjust them based on different clinical situation and we do it without thinking about it but we have to think about that new generation that may have not had that opportunity to really critically analyze those things and this is a way that you can engage and to get them to understand how you went about making the decision you made clinically.

This is a good tool that I like to use that is very quick and simple. It’s something that you can do almost every time you are working with a different medical student or a different intern or resident that is coming into your OR. I really find that it’s very useful and that the students are appreciative of you taking that time out to engage them and have them think about the things they are doing. And this is how I practice.

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