ZynxAmbulatory Updated Content

For information pertaining to new or withdrawn evidence and other changes affecting order sets and rules in the ZynxAmbulatory modules during January through March 2013, click here.

General Announcements

• ZynxAmbulatory now comprises 76 modules, 53 submodules, 55 forecasters, 226 rules, 117 order sets, and 39 care management checklists.

Clinical Highlights

• Atrial Fibrillation
  
  
• Due to the addition of new evidence on increased mortality among patients taking digoxin in patients with atrial fibrillation, all digoxin orders have been removed from and the following reminder has been added to the order set:
  
  
  • Inappropriate Use > Routine use of digoxin
    

• Diabetes Mellitus – Adult
  
  
  • Due to the addition of multiple studies, the following reminder has been added to the order set:
    
    
    • For selected patients with diabetes mellitus who require insulin, consider insulin pen therapy
      
      
• Osteoporosis/Osteopenia
  
  
• Due to the addition of a guideline on osteoporosis in men from the Endocrine Society, the following items have been added to the order set:
  
  
• For men with a recent hip fracture, consider zoledronic acid as the agent of choice
• Testosterone level, total
  

• Otitis Media – Pediatric
  
  
• Due to an updated guideline on the diagnosis and management of acute otitis media from the American Academy of Pediatrics, the following new or revised reminders appear in the order set:
  
  
• For patients 6 months or older with acute otitis media who meet certain criteria, consider delayed prescription of antibiotic therapy or watchful waiting (changed from “For selected pediatric patients, consider delayed prescription of antibiotic therapy or watchful waiting”)
• Inappropriate Use > Routine use of prophylactic antibiotics for recurrent acute otitis media
  
  
• Due to an updated guideline on the diagnosis and management of acute otitis media from the American Academy of Pediatrics, the following items have been removed from the order set:
  
  
• Consider the use of antimicrobial prophylaxis in patients at increased risk for recurrent acute otitis media
• Macrolides

• Prenatal Care
  
  
• Due to an update of the recommended immunization schedule for adults from the Centers for Disease Control and Prevention, the following reminder has been updated in the order set:
  
  
• For all patients, administer Tdap (preferably at 27 to 36 weeks of gestation), regardless of the number of years since the previous dose of Tdap or Td vaccination (changed from “For patients who have never received Tdap, administer Tdap during the third trimester or late second trimester [after 20 weeks of gestation]”)

• Preventive Care and Screening – Adult
  
  
• Due to the addition of a guideline on the management of dyslipidemia and prevention of atherosclerosis from the American Association of Clinical Endocrinologists, the following revised reminders appear in the order set:
  
  
• All men 20 years or older should have routine dyslipidemia screening at least every 5 years; consider screening every 1 to 2 years if 45 years or older or CHD risk factors are present (changed from “All men 35 years or older should have routine dyslipidemia screening; men 20 through 34 years of age who are at increased risk of CHD should have dyslipidemia screening” and “There is inconclusive evidence regarding dyslipidemia screening for men 20 through 34 years of age who are not at increased risk for CHD events”)
• All women 20 years or older should have routine dyslipidemia screening at least every 5 years; consider screening every 1 to 2 years if 55 years or older or CHD risk factors are present (changed from “There is inconclusive evidence regarding dyslipidemia screening for women 20 years or older who are not at increased risk for CHD events” and “Women 20 years or older who are at increased risk of CHD should have dyslipidemia screening”)

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