Error Reduction When Prescribing Neonatal Parenteral Nutrition

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.

Effect of a Comprehensive Total Parenteral Nutrition Training Program on Knowledge and Practice of Nurses in NICU

“…Taheri et al showed that the main causes of error in medication prescription in NICU from the nurses' perspective included limited number of staff (9.26%), heavy work load (17.6%), physical and psychological fatigue (14.3%), and hustle and bustle of the ward (12.6%), followed by other causes (TAHERI, NOORIAN, RASSOULI, & KAVOUSI). This is while, in Al-Rafay's research, the overall practice of the nurses after the completion of training course showed a significant difference (p<0.001), which was inconsistent with this study Brown et al (2007) found that the PN practice score of the nurses was higher than that of pediatric residents. After educational intervention, practice scores of the residents and nurses reached the same level, indicating the effect of such intervention on the practice.…”

“…In this regard, he compared his research data with those of Brown's educational intervention in relation to the use of inactive computerized sheets to reduce error rate in PN prescription. He noticed that the application of this method systematically improved the knowledge of senior clinical nurses and pediatric residents and decreased their mistakes in PN prescription (Brown, Garrison, & Hutchison, 2007).…”

Interventions to Reduce Pediatric Medication Errors: A Systematic Review

“…Of the 26 CPOE interventions, 4 investigated the effects of CPOE without CDS compared with manual order entry 33,74,77,79 and reported a 44% to 88% reduction in prescribing errors. Five studies examined the effect of CPOE with CDS for multiple medications on inpatients 45,46,51,73,88 and found a 14% increase in errors to a 99% decrease in all types of errors.…”

A.S.P.E.N. Clinical Guidelines

“…[25][26][27] Specifically with PN prescribing, 4 small observational studies seem to show benefit in educating healthcare professionals. 23,[28][29][30] Each of these studies had small sample sizes and implemented a new PN order form or system along with physician education as a primary or secondary goal. All 4 studies concluded that the new form and education led to a substantial decrease in overall PN prescription errors, overutilization of PN, overfeeding, and/or associated cost.…”

“…All 4 studies concluded that the new form and education led to a substantial decrease in overall PN prescription errors, overutilization of PN, overfeeding, and/or associated cost. 23,[28][29][30] Question 2. What is the maximum safe osmolarity of PN admixtures intended for peripheral vein administration?…”