BACKGROUND: Continuous bladder irrigation (CBI) is a long-standing treatment used in the setting of gross @entity811 and other acute bladder issues. Its use has traditionally been reserved for @entity1 under direct urologic care, but with the constraints of modern large-hospital healthcare, many @entity1 have CBI administered by providers unfamiliar with its use and potential complications. FINDINGS: There were 136 CBI orders placed in 2013 by non-urologic providers. The biggest hazard found in our analysis was the requirement for entering a rate of irrigation administration. Nurses with no experience with CBI viewed this order as an indication to administer via an infusion pump, which can easily exceed the mechanical integrity of the bladder and increase the risk of @entity1494 . Our panel also found that due to lack of experience by nurses and non-urologic providers, that signs and symptoms of @entity1494 were not common knowledge. Also we found that non-urologic providers were unfamiliar with administration and dosing of medications for CBI @entity1 to help with the intrinsic discomfort with CBI administration. CONCLUSIONS: In our revised order set we found that removing the requirement for an infusion rate, along with placing warnings in the CPOE, helped staff better understand this possible complication. We created a best practice alert in our CPOE to strongly recommend the urology service be consulted. Communication text boxes were added to the order set to help staff be aware of the signs and symptoms of @entity1494 , along with a guide for trouble shooting.

The pitfalls of electronic health orders: development of an enhanced institutional protocol after a preventable XXXX death.

@entity1 :: ('9606', 'Species') :: ['patients'] @entity811 :: ('MESH:D006417', 'Disease') :: ['hematuria'] @entity1494 :: ('MESH:D001745', 'Disease') :: ['CBI dysfunction', 'bladder perforation']
@entity1 :: (9606,Species) :: ['patient']
