title: Medication administration variances before and after implementation of computerized physician order entry in a neonatal intensive care unit.
abstract: OBJECTIVE
  The goal was to determine whether implementation of a computerized physician order entry system was associated with a decrease in medication administration variances in a NICU.
  
  
  METHODS
  A prospective observational study was conducted. Research nurses recorded details of medication administrations for patients in a NICU during standardized observation periods. Details of each administration were compared with the medication order; a variance was defined as a discrepancy between the order and the medication administration. Rates of variances before and after implementation of computerized physician order entry in the NICU were compared. Specific types of and reasons for variances were also compared.
  
  
  RESULTS
  Data on 526 medication administrations, including 254 during the pre-computerized physician order entry period and 272 after implementation of computerized physician order entry, were collected. Medication variances were detected for 19.8% of administrations during the pre-computerized physician order entry period, compared with 11.6% with computerized physician order entry (rate ratio: 0.53). Overall, administration mistakes, prescribing problems, and pharmacy problems accounted for 74% of medication variances; there were no statistically significant differences in rates for any of these specific reasons before versus after introduction of computerized physician order entry. Administration of a medication at the wrong time accounted for 53.1% of all variances. Variance rates related to giving a drug at the wrong time were significantly lower in the computerized physician order entry period than in the pre-computerized physician order entry period (rates: 6.7% and 9.9%, respectively; rate ratio: 0.53).
  
  
  CONCLUSIONS
  Implementation of computerized physician order entry in a NICU was associated with a significant decrease in the rate of medication administration variances. However, even with the use of computerized physician order entry, variances were noted for >11% of all medication administrations, which suggests that additional methods may be needed to improve neonatal patient safety.
authors.affiliation: Department of Pediatrics, University of Washington, Box 354920, Seattle, WA 98195, USA. uncjat@u.washington.edu
authors.forename: James A
authors.initials: JA
authors.lastname: Taylor
authors.forename: Lori A
authors.initials: LA
authors.lastname: Loan
authors.forename: Judy
authors.initials: J
authors.lastname: Kamara
authors.forename: Susan
authors.initials: S
authors.lastname: Blackburn
authors.forename: Donna
authors.initials: D
authors.lastname: Whitney
mesh_terms: D000328:Adult; D016001:Confidence Intervals; D004360:Drug Therapy, Computer-Assisted / Q000592:standards* / Q000639:trends; D005260:Female; D005544:Forecasting; D006801:Humans; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000175:diagnosis / Q000188:drug therapy*; D007363:Intensive Care Units, Neonatal; D015931:Intensive Care, Neonatal / Q000592:standards / Q000639:trends; D008297:Male; D050316:Medical Order Entry Systems / Q000592:standards* / Q000639:trends; D008508:Medication Errors / Q000517:prevention & control*; D011336:Probability; D011446:Prospective Studies; D012016:Reference Values; D012307:Risk Factors; D012680:Sensitivity and Specificity; D014861:Washington