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.

An In-Service Educational Package Improves Alarm Management in the Neonatal Intensive Care Unit (NICU): Before and After Study

2021 ◽  
pp. 097321792110512
Author(s):  
Suryaprakash Hedda ◽  
Shashidhar A. ◽  
Saudamini Nesargi ◽  
Kalyan Chakravarthy Balla ◽  
Prashantha Y. N. ◽  
...  
Keyword(s):  
Health Care ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Response Time ◽  
Neonatal Intensive Care Unit ◽  
Neonatal Intensive Care ◽  
Alarm Management ◽  
Educational Package ◽  
Before And After ◽  
Before And After Study

Background: Monitoring in neonatal intensive care unit (NICU) largely relies on equipment which have a number of alarms that are often quite loud. This creates a noisy environment, and moreover leads to desensitization of health-care personnel, whereby potentially important alarms may also be ignored. The objective was to evaluate the effect of an educational package on alarm management (the number of alarms, response to alarms, and appropriateness of settings). Methods: A before and after study was conducted at a tertiary neonatal care center in a teaching hospital in India involving all health-care professionals (HCP) working in the high dependency unit. The intervention consisted of demo lectures about working of alarms and bedside demonstrations of customizing alarm limits. A pre- and postintervention questionnaire was also administered to assess knowledge and attitude toward alarms. The outcomes were the number and type of alarms, response time, appropriateness of HCP response, and appropriateness of alarm limits as observed across a 24-h period which were compared before and after the intervention. Findings: The intervention resulted in a significant decrease in the number of alarms (11.6-9.6/h). The number of times where appropriate alarm settings were used improved from 24.3% to 67.1% ( P < .001). The response time to alarm did not change significantly (225 s vs 200 s); however, the appropriate response to alarms improved significantly from 15.6% to 68.8%. Conclusion: A simple structured intervention can improve the appropriate management of alarms. Application to Practice: Customizing alarm limits and nursing education reduce the alarm burden in NICUs

Effectiveness of Breast Massage on Expression of Breast Milk among Mothers of Neonates admitted in Neonatal Intensive Care Unit

2016 ◽  
Vol 8 (1) ◽  
pp. 21-24 ◽  
Author(s):  
Lekha Viswanath ◽  
A Divya ◽  
Anju Philip
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Breast Milk ◽  
Neonatal Intensive Care Unit ◽  
Neonatal Intensive Care ◽  
Pain Scale ◽  
Breast Milk Expression ◽  
Breast Milk Production ◽  
Before And After ◽  
The Mean

ABSTRACT Massaging the breast may help a postnatal mother to improve breast milk production, alleviate breast engorgement and facilitate breast milk expression. The purpose of the present study was to identify the effect of breast massage on breast milk expression in terms of volume of breast milk expressed, pain during breast milk expression and experience of breast milk expression among mothers of neonates admitted in neonatal intensive care unit (NICU). Materials and methods The quasi-experimental study was conducted among 30 postnatal mothers whose babies were admitted in NICU, selected as a sample of convenience. The design used was time series research design. After the pretest, breast massage was taught to the mothers by the investigator. Breast massage was performed for 10 minutes prior to each expression. The practice of breast massage and breast milk expression is observed by the investigator using a checklist during the next expression. Volume of breast milk expressed and pain during breast milk expression were assessed three times before and after the intervention using a standardized measuring cup and numerical pain scale respectively. The experience of breast milk expression was assessed before and after intervention using breast milk expression experience measure. Analysis was done using mean, frequency, percentage and paired t-test. Major findings The results show that the mean pretest volume of milk expressed in milliliters was 7.33 ± 4.86, which increased to 15.56 ± 8.38 (t = 4.22, p = 0.001) after the intervention. The mean pretest pain score was 7.50 ± 1.42 which decreased to 5.01 ± 1.37 (t = 11.73, p = 0.001) after the intervention. The experience of breast milk expression in post-test 37.6 ± 3.88 was significantly higher than pretest 28.4 ± 4.73 (t = 11.25, p = 0.001). Conclusion The study findings conclude that the breast massage is effective in increasing the volume of expressed breast milk, reducing the pain during breast milk expression and improving the experience of breast milk expression. How to cite this article Divya A, Viswanath L, Philip A. Effectiveness of Breast Massage on Expression of Breast Milk among Mothers of Neonates Admitted in Neonatal Intensive Care Unit. J South Asian Feder Obst Gynae 2016;8(1):21-24.

scholarly journals Guidelines for the Institutional Implementation of Developmental Neuroprotective Care in the Neonatal Intensive Care Unit. Part A

2017 ◽  
Vol 49 (2) ◽  
pp. 46-62 ◽  
Author(s):  
Isabelle Milette ◽  
Marie-Josée Martel ◽  
Margarida Ribeiro da Silva ◽  
Mary Coughlin McNeil
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Health Care Professionals ◽  
Neonatal Intensive Care ◽  
Care Delivery ◽  
Developmental Care ◽  
Appropriate Care ◽  
Age Appropriate ◽  
Core Measures

The use of age-appropriate care as an organized framework for care delivery in the neonatal intensive care unit is founded on the work of Heidelise Als, PhD, and her synactive theory of development. This theoretical construct has recently been advanced by the work of Gibbins and colleagues with the “universe of developmental care” conceptual model and developmental care core measures which were endorsed by the National Association of Neonatal Nurses in their age-appropriate care of premature infant guidelines as best-practice standards for the provision of high-quality care in the neonatal intensive care unit. These guidelines were recently revised and expanded. In alignment with the Joint Commission’s requirement for health-care professionals to provide age-specific care across the lifespan, the core measures for developmental care suggest the necessary competencies for those caring for the premature and critically ill hospitalized infant. Further supported by the Primer Standards of Accreditation and Health Canada, the institutional implementation of theses core measures requires a strong framework for institutional operationalization, presented in these guidelines. Part A of this article will present the background and rationale behind the present guidelines and their condensed table of recommendations.

Computerized physician order entry in the cardiac intensive care unit: Effects on prescription errors and workflow conditions

2014 ◽  
Vol 29 (2) ◽  
pp. 188-193 ◽  
Author(s):  
Eduardo R. Armada ◽  
Elena Villamañán ◽  
Esteban López-de-Sá ◽  
Sandra Rosillo ◽  
Juan Ramón Rey-Blas ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Computerized Physician Order Entry ◽  
Order Entry ◽  
Cardiac Intensive Care Unit ◽  
Prescription Errors ◽  
Cardiac Intensive Care ◽  
Physician Order Entry
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