title: Computer programming: quality and safety for neonatal parenteral nutrition orders.
abstract: BACKGROUND
  Computerized software programs reduce errors and increase consistency when ordering parenteral nutrition (PN). The purpose of this study was to evaluate the effectiveness of our computerized neonatal PN calculator ordering program in reducing errors and optimizing nutrient intake.
  
  
  METHODS
  This was a retrospective study of infants requiring PN during the first 2-3 weeks of life. Caloric, protein, calcium, and phosphorus intakes; days above and below amino acid (AA) goals; and PN ordering errors were recorded. Infants were divided into 3 groups by birth weight for analysis: ≤1000 g, 1001-1500 g, and >1500 g. Intakes and outcomes of infants before (2007) vs after (2009) implementation of the calculator for each group were compared.
  
  
  RESULTS
  There were no differences in caloric, protein, or phosphorus intakes in 2007 vs 2009 in any group. Mean protein intakes were 97%-99% of goal for ≤1000-g and 1001- to 1500-g infants in 2009 vs 87% of goal for each group in 2007. In 2007, 7.6 per 100 orders were above and 11.5 per 100 were below recommended AA intakes. Calcium intakes were higher in 2009 vs 2007 in ≤1000-g (46.6 ± 6.1 vs 39.5 ± 8.0 mg/kg/d, P < .001) and >1500-g infants (50.6 ± 7.4 vs 39.9 ± 8.3 mg/kg/d, P < .001). Ordering errors were reduced from 4.6 per 100 in 2007 to 0.1 per 100 in 2009.
  
  
  CONCLUSIONS
  Our study reaffirms that computerized ordering systems can increase the quality and safety of neonatal PN orders. Calcium and AA intakes were optimized and ordering errors were minimized using the computer-based ordering program.
authors.affiliation: Division of Neonatology, Randall Children's Hospital at Legacy Emanuel, 2801 N Gantenbein, Portland, OR 97227, USA. Bob@nwnewborn.com
authors.forename: Robert K
authors.initials: RK
authors.lastname: Huston
authors.forename: Andrea M
authors.initials: AM
authors.lastname: Markell
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: McCulley
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Marcus
authors.forename: Howard S
authors.initials: HS
authors.lastname: Cohen
mesh_terms: D002118:Calcium / Q000008:administration & dosage; D002136:Calcium, Dietary / Q000008:administration & dosage; D003201:Computers; D004044:Dietary Proteins / Q000008:administration & dosage; D002149:Energy Intake; D006801:Humans; D007231:Infant, Newborn; D015596:Nutrition Assessment; D057947:Parenteral Nutrition Solutions / Q000737:chemistry; D010289:Parenteral Nutrition, Total / Q000009:adverse effects / Q000379:methods / Q000592:standards*; D010758:Phosphorus / Q000008:administration & dosage; D016226:Phosphorus, Dietary / Q000008:administration & dosage; D055656:Prescriptions / Q000592:standards*; D012189:Retrospective Studies; D012984:Software / Q000592:standards*
chemical_list: D002136:Calcium, Dietary; D004044:Dietary Proteins; D057947:Parenteral Nutrition Solutions; D016226:Phosphorus, Dietary; D010758:Phosphorus; D002118:Calcium
keywords: amino acids; electronic health records; medical records; medical records systems, computerized; minerals; neonates; outcome assessment; parenteral nutrition