Zynx Update March 2013
 

ZynxOrder Updated Content

For information pertaining to new or withdrawn evidence and other changes affecting order sets and rules in the ZynxOrder modules during January through March 2013, click here.

General Announcements

  • ZynxOrder now comprises 154 modules, 12 submodules, 299 rules, and 574 order sets.
  • ZynxOrder – Oncology now comprises 12 modules, 146 order sets, and 2 forecasters.
  • The names of venues have been taken out of the modular order set titles: “Modular Order Set (ICU and Med/Surg)” and “Modular Order Set (ICU and Telemetry)” are now “Modular Orders.”
  • The following order sets were deemed unnecessary to clinician workflow and were therefore eliminated:

Module

Venue
Anorectal Malformation – Neonatal Discharge
Croup – Pediatric Discharge
Gastrointestinal Bleeding – Lower Discharge
Meconium Aspiration – Neonatal Discharge
Preeclampsia/Gestational Hypertension Discharge
Preterm Labor Discharge
Retinopathy of Prematurity – Neonatal Admission to Level II Nursery/NICU
Admission to Level III NICU
Discharge

New ZynxOrder Module

  • 1 module has been added during January through March 2013:

    • Antimicrobials – Empiric, Adult

New ZynxOrder Order Sets

  • 7 order sets have been added during January through March 2013:

Module

Venue
Antimicrobials – Empiric, Adult Modular Orders*
Critical Care Management – Adult Short Set > Venue > Modular Orders
General Medical Care – Common Practice Short Set > Venue > Modular Orders
Medications – Common Practice Short Set > Medications > Insulins > Regimens
Retinopathy of Prematurity – Neonatal Modular Orders

*We created a new modular order set “Antimicrobials – Empiric, Adult,” which is based on the Infectious Diseases Society of America (IDSA) guidelines for the following conditions and consists of medications only:

  • Acute Uncomplicated Cystitis and Pyelonephritis in Women
  • Bacterial Meningitis
  • Catheter-Associated Urinary Tract Infection
  • Community-Acquired Pneumonia
  • Complicated Intra-abdominal Infection

Split ZynxOrder Order Sets

  • Diabetes Mellitus – Gestational order set has now been split into two:

    • Short Set > Management > Gestational Diabetes Mellitus – Antepartum
    • Short Set > Management > Gestational Diabetes Mellitus – Intrapartum

New ZynxOrder – Oncology Order Sets

  • 2 order sets have been added during January through March 2013:

Module

Folder

Venue
Cancer – Breast, Stage IV Multiple-Drug Regimens DOCEtaxel + Pertuzumab + Trastuzumab
Cancer – Lung, Small Cell Single-Drug Regimens Temozolomide
Single-Drug Regimens Bendamustine

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 the order sets

  • Critical Care Management – Adult

    • Due to an updated guideline on the management of pain, agitation, and delirium in adult patients in the ICU from the American College of Critical Care Medicine/Society of Critical Care Medicine/American Society of Health-System Pharmacists, the following order items and reminders have been added to the order sets:

      • Dexmedetomidine 1 microgram/kilogram intravenously once loading dose
      • Dexmedetomidine 0.2 microgram/kilogram per hour continuous intravenous infusion maintenance dose
      • Encourage early mobilization to reduce the incidence and duration of delirium
      • For mechanically ventilated patients, nonbenzodiazepines (propofol, dexmedetomidine) may be preferred over benzodiazepines (midazolam, LORazepam) for sedation to improve clinical outcomes
  • Delirium

    • Due to an updated guideline for the management of pain, agitation, and delirium in adult patients in the ICU from the American College of Critical Care Medicine/Society of Critical Care Medicine/American Society of Health-System Pharmacists, the following order items and reminder have been added to the order sets:

      • Dexmedetomidine 1 microgram/kilogram intravenously once loading dose
      • Dexmedetomidine 0.2 microgram/kilogram per hour continuous intravenous infusion maintenance dose
      • For patients with delirium unrelated to alcohol or benzodiazepine withdrawal, consider a continuous IV infusion of dexmedetomidine for sedation, rather than a benzodiazepine

  • Endotracheal Intubation

    • Due to an updated guideline for the management of pain, agitation, and delirium in adult patients in the ICU from the American College of Critical Care Medicine/Society of Critical Care Medicine/American Society of Health-System Pharmacists, the following order items have been added to the order sets :

      • Dexmedetomidine 1 microgram/kilogram intravenously once loading dose
      • Dexmedetomidine 0.2 microgram/kilogram per hour continuous intravenous infusion maintenance dose
  • Preeclampsia/Gestational Hypertension

    • Due to the addition of a guideline on emergent therapy for acute-onset, severe hypertension with preeclampsia or eclampsia from the American College of Obstetricians and Gynecologists, the following reminder has been updated in the order sets:

      • For BP greater than or equal to 160/105 mm Hg, administer hydrALAZINE or labetalol (changed from “For patients with diastolic BP greater than or equal to 105 mm Hg, administer antihypertensive therapy in the form of hydrALAZINE or labetalol”)

 

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Zynx Update does not address the addition, deletion, or modification of clinical rules, nor does it address the addition of items or the deletion of non–evidence-based items from order sets or plans of care. Zynx Update is intended for use by quality improvement personnel who can review the information provided to help decide if modifications should be made to existing order sets, plans of care, and rules, based on changes to the evidence.