Implementation of computerized provider order entry in a neonatal intensive care unit: Impact on admission workflow

2012 ◽  
Vol 81 (5) ◽  
pp. 291-295 ◽  
Author(s):  
Alison K. Chapman ◽  
Christoph U. Lehmann ◽  
Pamela K. Donohue ◽  
Susan W. Aucott
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Neonatal Intensive Care ◽  
Order Entry ◽  
Computerized Provider Order Entry

scholarly journals Examining Perceptions of Computerized Physician Order Entry in a Neonatal Intensive Care Unit

2017 ◽  
Vol 08 (02) ◽  
pp. 337-347 ◽  
Author(s):  
Kristyn Beam ◽  
Megan Cardoso ◽  
Megan Sweeney ◽  
Geoff Binney ◽  
Saul Weingart
Keyword(s):  
Job Satisfaction ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Neonatal Intensive Care ◽  
Care Delivery ◽  
Computerized Physician Order Entry ◽  
Order Entry ◽  
Before And After ◽  
Physician Order Entry

SummaryBackground: Computerized provider order entry (CPOE) is a technology with potential to transform care delivery. While CPOE systems have been studied in adult populations, less is known about the implementation of CPOE in the neonatal intensive care unit (NICU) and perceptions of nurses and physicians using the system.Objective: To examine perceptions of clinicians before and after CPOE implementation in the NICU of a pediatric hospital.Methods: A cross-sectional survey of clinicians working in a Level III NICU was conducted. The survey was distributed before and after CPOE implementation. Participants were asked about their perception of CPOE on patient care delivery, implementation of the system, and effect on job satisfaction. A qualitative section inquired about additional concerns surrounding implementation. Responses were tabulated and analyzed using the Chi-square test.Results: The survey was distributed to 158 clinicians with a 47% response rate for pre-implementation and 45% for post-implementation. Clinicians understood why CPOE was implemented, but felt there was incomplete technical training. The expectation for increased job satisfaction and ability to recruit high-quality staff was high. However, there was concern about the ability to deliver appropriate treatments before and after implementation. Physicians were more optimistic about CPOE implementation than nurses who remained concerned that workflow may be altered.Conclusions: Introducing CPOE is a potentially risky endeavor and must be done carefully to mitigate harm. Although high expectations of the system can be met, it is important to attend to differing expectations among clinicians with varied levels of comfort with technology. Interdisciplinary collaboration is critical in planning a functioning CPOE to ensure that efficient workflow is maintained and appropriate supports for individuals with a lower degree of technical literacy is available.Citation: Beam KS, Cardoso M, Sweeney M, Binney G, Weingart SN. Examining perceptions of computerized physician order entry in a neonatal intensive care unit. Appl Clin Inform 2017; 8: 337–347 https://doi.org/10.4338/ACI-2016-09-RA-0153

scholarly journals Computerized Physician Order Entry in the Neonatal Intensive Care Unit: A Narrative Review

2019 ◽  
Vol 10 (03) ◽  
pp. 487-494
Author(s):  
Jaclyn B. York ◽  
Megan Z. Cardoso ◽  
Dara S. Azuma ◽  
Kristyn S. Beam ◽  
Geoffrey G. Binney ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Clinical Practice ◽  
Neonatal Intensive Care Unit ◽  
Medication Safety ◽  
Neonatal Intensive Care ◽  
Computerized Physician Order Entry ◽  
Order Entry ◽  
Exclusion Criteria ◽  
Physician Order Entry

Background Computerized physician order entry (CPOE) has grown since the early 1990s. While many systems serve adult patients, systems for pediatric and neonatal populations have lagged. Adapting adult CPOE systems for pediatric use may require significant modifications to address complexities associated with pediatric care such as daily weight changes and small medication doses. Objective This article aims to review the neonatal intensive care unit (NICU) CPOE literature to characterize trends in the introduction of this technology and to identify potential areas for further research. Methods Articles pertaining to NICU CPOE were identified in MEDLINE using MeSH terms “medical order entry systems,” “drug therapy,” “intensive care unit, neonatal,” “infant, newborn,” etc. Two physician reviewers evaluated each article for inclusion and exclusion criteria. Consensus judgments were used to classify the articles into five categories: medication safety, usability/alerts, clinical practice, clinical decision Support (CDS), and implementation. Articles addressing pediatric (nonneonatal) CPOE were included if they were applicable to the NICU setting. Results Sixty-nine articles were identified using MeSH search criteria. Twenty-two additional articles were identified by hand-searching bibliographies and 6 articles were added after the review process. Fifty-five articles met exclusion criteria, for a final set of 42 articles. Medication safety was the focus of 22 articles, followed by clinical practice (10), CDS (10), implementation (11), and usability/alerts (4). Several addressed more than one category. No study showed a decrease in medication safety post-CPOE implementation. Within clinical practice articles, CPOE implementation showed no effect on blood glucose levels or time to antibiotic administration but showed conflicting results on mortality rates. Implementation studies were largely descriptive of single-hospital experiences. Conclusion CPOE implementation within the NICU has demonstrated improvement in medication safety, with the most consistent benefit involving a reduction in medication errors and wrong-time administration errors. Additional research is needed to understand the potential limitations of CPOE systems in neonatal intensive care and how CPOE affects mortality.

The Psychosocial Aspects of Feeding in the Neonatal Intensive Care Unit and Beyond

2019 ◽  
Vol 4 (6) ◽  
pp. 1507-1515
Author(s):  
Lauren L. Madhoun ◽  
Robert Dempster
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Hospital Discharge ◽  
Neonatal Intensive Care ◽  
Oral Feeding ◽  
Medical Attention ◽  
Primary Role ◽  
Speech Language Pathologists ◽  
The Family

Purpose Feeding challenges are common for infants in the neonatal intensive care unit (NICU). While sufficient oral feeding is typically a goal during NICU admission, this can be a long and complicated process for both the infant and the family. Many of the stressors related to feeding persist long after hospital discharge, which results in the parents taking the primary role of navigating the infant's course to ensure continued feeding success. This is in addition to dealing with the psychological impact of having a child requiring increased medical attention and the need to continue to fulfill the demands at home. In this clinical focus article, we examine 3 main areas that impact psychosocial stress among parents with infants in the NICU and following discharge: parenting, feeding, and supports. Implications for speech-language pathologists working with these infants and their families are discussed. A case example is also included to describe the treatment course of an infant and her parents in the NICU and after graduation to demonstrate these points further. Conclusion Speech-language pathologists working with infants in the NICU and following hospital discharge must realize the family context and psychosocial considerations that impact feeding progression. Understanding these factors may improve parental engagement to more effectively tailor treatment approaches to meet the needs of the child and family.

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