Implementation of computerized provider order entry in a neonatal intensive care unit: Impact on admission workflow.
OBJECTIVE
The study objective was to determine if computerized provider order entry (CPOE) systems impaired or enhanced workflow in the neonatal intensive care unit (NICU) by comparing the timing of administration of the first dose of antibiotics before and after CPOE system implementation.


METHODS
We conducted a pre-post intervention comparative study of the length of time between admission and administration of initial antibiotics in neonates before and after a CPOE system was implemented. Clinical information and timing of antibiotic administration were collected on all inborn infants, who were admitted to the NICU in the first 4h of life and treated with antibiotics, for one year prior to the implementation of computerized order entry and for one year after the implementation.


RESULTS
Infants admitted to the NICU were similar in both periods (mean birth weight 2183 g vs. 2091 g, gestational age 33.3 weeks vs. 33.0 weeks). There was no significant difference in mean length of time from admission to antibiotic administration in the pre-CPOE group (131 min [CI 124-139]) compared to the post-CPOE group (125 min [CI 116-133]) (p=0.07). The mean time to pharmacy verification for a subset of patients was significantly shorter for patients in the post-CPOE group (61 ± 58 min) compared to the pre-CPOE group (88 ± 76 min) (p=<0.001).


CONCLUSIONS
While the introduction of a CPOE system in the NICU did not significantly improve antibiotic administration times, the timeliness of an important aspect of the medication process, time to pharmacy verification, was improved. These findings imply other factors are impeding workflow. Further studies are needed to evaluate how CPOE systems combined with patient care activities affect workflow and overall patient care.
Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA. achapman@mcvh-vcu.edu
Alison K
AK
Chapman
Christoph U
CU
Lehmann
Pamela K
PK
Donohue
Susan W
SW
Aucott
D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D016303:Clinical Pharmacy Information Systems; D020000:Decision Support Systems, Clinical; D004360:Drug Therapy, Computer-Assisted; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal / Q000458:organization & administration*; D016347:Medical Records Systems, Computerized; D008508:Medication Errors / Q000517:prevention & control* / Q000706:statistics & numerical data; D008510:Medication Systems, Hospital / Q000458:organization & administration*; D008875:Middle Aged; D010343:Patient Admission; D018805:Sepsis / Q000188:drug therapy; D012984:Software; D057188:Workflow; D055815:Young Adult
D000900:Anti-Bacterial Agents