ZynxOrder Updated Content

For information pertaining to new or withdrawn evidence and other changes affecting order sets and rules in the ZynxOrder modules during April through June 2012, click here.

General Announcements

• ZynxOrder now comprises 152 modules, 33 submodules, 290 rules, and 703 order sets (which includes 126 starter order sets).
• ZynxOrder – Oncology now comprises 13 modules, 188 order sets, and 8 forecasters.
• Two changes are being piloted for ZynxOrder content: “Modular” order sets and more “Starter” sets. Modular order sets are created when several venues are combined into a single order set that excludes common practice venue-related items such as diet. A Modular order set is being released for the Stroke – Ischemic module. Starter sets are created using a starter set methodology aimed at minimizing common practice, respiratory, diet, and imaging items, and eliminating inconclusive reminders as well as individual lab tests that would be included in standard panels. Starter sets are being applied and released to all venues in the following modules: Coronary Artery Bypass Graft Surgery, Heart Valve Replacement, Stroke – Ischemic, Transient Ischemic Attack, Total Hip Replacement, and Total Knee Replacement.
• A new medication section containing beta-blockers for perioperative use has been added to the Hospital Preoperative, Postoperative, and Discharge venues of the Perioperative Care order set. These order sets can be linked to individual condition order sets, or the individual order items can be incorporated into client-customized surgical order sets.
  

New ZynxOrder Order Sets

• 4 order sets have been added during April through June 2012:

New ZynxOrder – Oncology Order Sets

• 5 order sets have been added during April through June 2012:

Clinical Highlights

• Acute Myocardial Infarction/STEMI
• Unstable Angina/NSTEMI
  
  
• Due to an updated guideline for the primary and secondary prevention of cardiovascular disease for antithrombotic therapy and prevention of thrombosis from the American College of Chest Physicians, the following order items have been added to the order sets:
  
  
• ticagrelor 180 milligram orally once loading dose
• ticagrelor 90 milligram orally 2 times a day maintenance dose
  
  
• Chronic Obstructive Pulmonary Disease
  
  
• Due to the withdrawal of a guideline for global strategy for diagnosis, management, and prevention of chronic obstructive pulmonary disease from the Global Initiative for Chronic Obstructive Lung Disease, the following reminder has been removed from the order sets:
  
  
• For selected patients who need help with clearing sputum, consider the use of physiotherapy

• Newborn Management
• Prematurity – Neonatal
  
  
• Due to an updated guideline on the use of antiretroviral drugs in pregnant HIV-1–infected women for maternal health and interventions to reduce perinatal HIV transmission in the United States from the US Department of Health and Human Services, medication dosing for zidovudine has been updated in the order sets

• Sepsis – Neonatal
  
  
• Due to the addition of new evidence from Brocklehurst et al (INIS Collaborative Group, 2011), the following order item has been removed from the order sets:
  
  
• immune globulin (human) (IgG) 500 milligram/kilogram intravenously once
  
  
• Stroke – Ischemic
• Transient Ischemic Attack
  
  
• Due to an updated guideline for antithrombotic and thrombolytic therapy for ischemic stroke from the American College of Chest Physicians, the following order item and reminder have been added to the order sets:
  
  
• dabigatran 150 milligram orally 2 times a day
• For patients with history of TIA or stroke associated with atrial fibrillation, consider the use of dabigatran in preference to warfarin
  
  
• Due to an updated guideline for antithrombotic and thrombolytic therapy for ischemic stroke from the American College of Chest Physicians, the following order items have been removed from the order sets:
  
  
  • aspirin 81 milligram orally once
  • aspirin 81 milligram orally once a day

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