Impact of Computerized Provider Order Entry on Total Parenteral Nutrition in the Neonatal Intensive Care Unit

Abstract

To determine if computerized provider order entry (CPOE) implementation impacts the time it takes for preterm neonates to reach their parenteral macronutrient goals. Retrospective review of neonates<1750 g receiving parenteral nutrition (PN) before and after the implementation of CPOE. Primary outcome was the attainment of parenteral macronutrient goals. Secondary outcomes included time to attainment, the frequency of electrolyte abnormalities, and the incidence of required adjustments made to PN orders by verification pharmacists. Goal PN was achieved by 12/47 (25.5%) intervention vs. 2/44 (4.5%) control group infants (p< 0.05). This goal was attained in 10.8 ± 7.5 days in the intervention group and 10 ± 4.2 days in the control group (p = 0.90). Goal protein was reached by 74.5% of CPOE patients vs. 36.4% of controls, p < 0.05. Lipid goals were achieved by 98% vs. 100% (p = 0.33) of patients and were attained at an average of 1.5 ± 0.8 days vs. 2.0 ± 1.1 days (p < 0.05). Abnormal serum electrolyte values occurred more frequently in the control group (0.79 vs. 1.12/day PN). Adjustments by a verification pharmacist were required in 5.6% of CPOE compared with 30.4% of control group orders (p < 0.05). CPOE parenteral nutrition increased the proportion of preterm neonates attaining overall macronutrient goals. With CPOE, protein goals were reached by more patients and goal lipids were achieved faster. This system also decreased the number of pharmacist interventions during verification of PN orders and appeared to positively impact the incidence of serum electrolyte disturbances.

A triple‐chamber parenteral nutrition solution was associated with improved protein intake in very low birthweight infants

“…Similarly to our study, they used computerised assisted prescriptions. The use of a computeraided nutrition calculation programme or a computerised physician order entry for PN has been shown to improve the nutritional intake of very premature infants (10,11). Furthermore, our data support the updated European guidelines, where standard PN solutions are recommended instead of individual solutions.…”

Impact of Computer Calculation Program on Quality of Individualized Parenteral Nutrition and Selected Clinical Parameters of Extremely Low‐Birth‐Weight Infants

“…Although analysis revealed several significantly higher blood electrolyte values in the AC group, all values fell into normal ranges and seem to not be of clinical importance. Additionally, after the system was introduced, the need for pharmaceutical intervention for prescription verification was reduced 17 …”

Attainment Targets for Protein Intake Using Standardised, Concentrated and Individualised Neonatal Parenteral Nutrition Regimens

“…The reasons for lower target attainment with iNPN regimens are multifactorial but include limited aqNPN availability and the effect of additional drug infusions and fluid restriction. The iNPN regimen did not use computer-aided prescribing [21] or other decision support systems [42] which may have ameliorated the nutritional deficits with iNPN. Management of PN intolerance (e.g., hyperglycaemia, hyperlipidaemia) can also affect nutritional intake but the protocol for managing these challenges were the same in both RCT.…”

“…This has the potential to subvert early nutritional strategy particularly with inexperienced neonatal PN prescribers [16,17]. Computer-aided prescribing can help [18] and improve protein and energy intake [19,20,21]. Individualised NPN prescription and formulation does create major practical challenges for supply chains, thereby introducing unintended variation in actual NPN delivery to the patient.…”