Cordero Leandro, Kuehn Lynn, Kumar Rajee R, Mekhjian Hagop S
Pediatrics and Obstetrics, The Ohio State University Medical Center, Columbus, OH 43210, USA.
J Perinatol. 2004 Feb;24(2):88-93. doi: 10.1038/sj.jp.7211000.
To study the impact of computerized physician order entry (CPOE) on selected neonatal intensive care unit (NICU) practices.
Retrospective review.
Nursing units in an academic health system where CPOE has been implemented in adult services since 2000 and in the NICU since 2002.
Data from 111 very-low-birth-weight (VLBW) infants born consecutively within 6 months before and 100 VLBW infants born within 6 months after the implementation of CPOE were evaluated. The study is based on pre- and post-CPOE comparisons in medication error rates and on the initiation to completion time intervals for pharmacy orders and radiology procedures. The specific data subsets that were compared included caffeine and gentamicin. Radiology turn-around time (order to image display) for the first chest and abdominal X-ray taken following endotracheal intubation and/or umbilical catheter placement was studied.
Statistically significant (p<0.01) reductions were seen in medication turn-around times for the loading dose of caffeine in pre-CPOE (n=41, mean 10.5+/-9.8 SD hours) and post-CPOE (n=48, mean 2.8+/-3.3 SD hours). After CPOE implementation, the percentage of cases during each period where caffeine was administered before 2 and 3 hours increased from 10 to 35% and 12 to 63%, respectively. Accuracy of gentamicin dose at the time of admission for 105 (pre-CPOE) and 92 (post-CPOE) VLBW infants was determined. In the pre-CPOE period, 5% overdosages, 8% underdosages, and 87% correct dosages were identified. In the post-CPOE, no medication errors occurred. Accuracy of gentamicin dosages during hospitalization at the time of suspected late-onset sepsis for 31 pre- and 28 post-CPOE VLBW infants was studied. Gentamicin dose was calculated incorrectly in two of 31 (6%) pre-CPOE infants. No such errors were noted in the post-CPOE period. Radiology response time decreased significantly from the pre-CPOE (n=107, mean 42+/-12 SD minutes) to post-CPOE (n=95, mean 32+/-16 SD minutes).
The implementation of CPOE in our NICU resulted in a significant reduction in medication turn-around times and medication errors for selected drugs, and a decrease in ancillary service (radiology) response time. In spite of the complexities of medication orders in pediatric populations, commercially available software programs for CPOE can successfully be adjusted to accommodate NICU needs and to beneficially impact clinical practice.
研究计算机化医生医嘱录入系统（CPOE）对新生儿重症监护病房（NICU）特定医疗行为的影响。
回顾性研究。
一所学术性医疗系统中的护理单元，自2000年起在成人服务科室实施CPOE，自2002年起在NICU实施。
评估了在CPOE实施前6个月内连续出生的111例极低出生体重（VLBW）婴儿以及实施后6个月内出生的100例VLBW婴儿的数据。该研究基于CPOE实施前后药物错误率的比较，以及药房医嘱和放射检查流程从开始到完成的时间间隔。所比较的具体数据子集包括咖啡因和庆大霉素。研究了气管插管和/或脐静脉置管后首次胸部和腹部X线检查的放射检查周转时间（从医嘱到影像显示）。
在CPOE实施前（n = 41，平均10.5±9.8标准差小时）和实施后（n = 48，平均2.8±3.3标准差小时），咖啡因负荷剂量的药物周转时间有统计学显著降低（p<0.01）。CPOE实施后，在2小时和3小时之前给予咖啡因的病例百分比分别从10%增加到35%和从12%增加到63%。确定了105例（CPOE实施前）和92例（CPOE实施后）VLBW婴儿入院时庆大霉素剂量的准确性。在CPOE实施前阶段，发现5%的剂量过量、8%的剂量不足和87%的剂量正确。在CPOE实施后，未发生用药错误。研究了31例CPOE实施前和28例CPOE实施后VLBW婴儿在疑似迟发性败血症时住院期间庆大霉素剂量的准确性。在31例CPOE实施前的婴儿中有2例（6%）庆大霉素剂量计算错误。在CPOE实施后阶段未发现此类错误。放射检查响应时间从CPOE实施前（n = 107，平均42±12标准差分钟）到实施后（n = 95，平均32±16标准差分钟）显著缩短。
在我们的NICU实施CPOE后，特定药物的药物周转时间和用药错误显著减少，辅助服务（放射检查）响应时间缩短。尽管儿科人群的用药医嘱复杂，但市售的CPOE软件程序可成功调整以满足NICU需求，并对临床实践产生有益影响。
