title: The effect of a computerized prescribing and calculating system on hypo- and hyperglycemias and on prescribing time efficiency in neonatal intensive care patients.
abstract: BACKGROUND
  Prescribing glucose requires complex calculations because glucose is present in parenteral and enteral nutrition and drug vehicles, making it error prone and contributing to the burden of prescribing errors.
  
  
  OBJECTIVE
  Evaluation of the impact of a computerized physician order entry (CPOE) system with clinical decision support (CDS) for glucose control in neonatal intensive care patients (NICU) focusing on hypo- and hyperglycemic episodes and prescribing time efficiency.
  
  
  METHODS
  An interrupted time-series design to examine the effect of CPOE on hypo- and hyperglycemias and a crossover simulation study to examine the influence of CPOE on prescribing time efficiency. NICU patients at risk for glucose imbalance hospitalized at the University Medical Center Utrecht during 2001-2007 were selected. The risks of hypo- and hyperglycemias were expressed as incidences per 100 patient days in consecutive 3-month intervals during 3 years before and after CPOE implementation. To assess prescribing time efficiency, time needed to calculate glucose intake with and without CPOE was measured.
  
  
  RESULTS
  No significant difference was found between pre- and post-CPOE mean incidences of hypo- and hyperglycemias per 100 hospital days of neonates at risk in every 3-month period (hypoglycemias, 4.0 [95% confidence interval, 3.2-4.8] pre-CPOE and 3.1 [2.7-3.5] post-CPOE, P = .88; hyperglycemias, 6.0 [4.3-7.7] pre-CPOE and 5.0 [3.7-6.3] post-CPOE, P = .75). CPOE led to a significant time reduction of 16% (1.3 [0.3-2.3] minutes) for simple and 60% (8.6 [5.1-12.1] minutes) for complex calculations.
  
  
  CONCLUSIONS
  CPOE including a special CDS tool preserved accuracy for calculation and control of glucose intake and increased prescribing time efficiency.
authors.affiliation: Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht, The Netherlands. B.Maat@umcutrecht.nl
authors.forename: Barbara
authors.initials: B
authors.lastname: Maat
authors.forename: Carin M A
authors.initials: CM
authors.lastname: Rademaker
authors.forename: Marloes I
authors.initials: MI
authors.lastname: Oostveen
authors.forename: Tannette G
authors.initials: TG
authors.lastname: Krediet
authors.forename: Toine C G
authors.initials: TC
authors.lastname: Egberts
authors.forename: Casper W
authors.initials: CW
authors.lastname: Bollen
mesh_terms: D020000:Decision Support Systems, Clinical; D004526:Efficiency; D005260:Female; D005947:Glucose / Q000008:administration & dosage* / Q000627:therapeutic use; D006801:Humans; D006943:Hyperglycemia / Q000517:prevention & control; D007003:Hypoglycemia / Q000188:drug therapy; D015994:Incidence; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D015931:Intensive Care, Neonatal / Q000379:methods*; D008297:Male; D050316:Medical Order Entry Systems; D008508:Medication Errors / Q000517:prevention & control; D055656:Prescriptions; D012306:Risk
chemical_list: D005947:Glucose