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Am J Perinatol 2007; 24(7): 417-427
DOI: 10.1055/s-2007-984404
© Thieme Medical Publishers

Error Reduction When Prescribing Neonatal Parenteral Nutrition[*]

Cynthia L. Brown1 , Nancy A. Garrison2 , Alastair A. Hutchison3
  • 1Department of Pharmacy, University at Buffalo, State University of New York, The Women and Children's Hospital of Buffalo, Kaleida Health, Buffalo, New York
  • 2Department of Nutrition, University at Buffalo, State University of New York, The Women and Children's Hospital of Buffalo, Kaleida Health, Buffalo, New York
  • 3Department of Pediatrics, University at Buffalo, State University of New York, The Women and Children's Hospital of Buffalo, Kaleida Health, Buffalo, New York
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Publikationsdatum:
11. Juli 2007 (online)

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ABSTRACT

A neonatal intensive care unit audit of 204 parenteral nutrition (PN) orders revealed a 27.9% PN prescribing error rate, with errors by pediatric residents exceeding those by neonatal nurse practitioners (NNPs) (39% versus 16%; p < 0.001). Our objective was to reduce the PN prescribing error rate by implementing an ordering improvement process. An interactive computerized PN worksheet, used voluntarily, was introduced and its impact analyzed in a retrospective cross-sectional study. A time management study was performed. Analysis of 480 PN orders revealed that the PN prescribing error rate was 11.7%, with no difference in error rates between pediatric residents and NNPs (12.3% versus 10.5%). Use of the interactive computerized PN worksheet was associated with a reduction in the prescribing error rate from 14.5 to 6.8% for all PN orders (p = 0.016) and from 29.3 to 9.6% for peripheral PN orders (p = 0.002). All 12 errors that occurred in the 177 PN prescriptions completed using the computerized PN worksheet were due to avoidable data entry or transcription mistakes. The time management study led to system improvements in PN ordering. We recommend that an interactive computerized PN worksheet be used to prescribe peripheral PN and thus reduce errors.

KEYWORDS

Parenteral nutrition - neonate - prescribing errors - computerized parenteral nutrition worksheet - time management

0 March 2, 2009: This is a revised version of the article originally published online on July 11, 2007. The publisher apologies for the errors in the placement of Figures.

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0 March 2, 2009: This is a revised version of the article originally published online on July 11, 2007. The publisher apologies for the errors in the placement of Figures.

Alastair A HutchisonM.B. Ch.B. F.R.A.C.P. 

Division of Neonatology, Department of Pediatrics

University of South Florida, 2-A Columbia Drive, Tampa, FL 33606