Impact of Computerized Prescription on Medication Errors and Workflow Efficiency in Neonatal Intensive Care Units: A Quasi-Experimental Three-Phase StudyFunding The work was supported by the University of Jordan (Reference Grant number 28/2015-2016).
Background Neonates are highly vulnerable to preventable medication errors due to their extensive exposure to medications in the neonatal intensive care units (NICUs). These errors, which can be made by medical, nursing, or pharmacy personnel, are costly and can be life-threatening. This study aimed to investigate the newly developed computerized neonatal pharmaceutical health care system (NPHCS) in terms of its ability to (1) minimize neonatal medication prescription errors (NMPEs) and (2) improve workflow efficiency compared with the traditional manual prescribing approach.
Methods A computerized neonatal medication prescription system was designed, developed, and tested successfully through a pilot clinical trial for over 6 months in 100 neonates. A three phase quasi-experimental study was then conducted using standardized monitoring checklists for the assessment of NMPEs before and after utilization of the developed prescribing system.
Results The obtained result showed a high rate of NMPEs in both systems, especially for the antibiotic drug group. However, the use of newly developed NPHCS significantly improved workflow efficacy. The identified errors were significantly more common in the manual mode than in the computerized mode (158.8 vs. 55 per 100 medications). These errors were distributed among different categories, including the documentation of patient identity, birth weight, and gestational age, as well as statements of dose, unit, interval, and diagnosis. Analysis of variance across different categories showed a p-value of <0.05.
Conclusion The use of the computerized NPHCS improved patient safety in NICUs by decreasing NMPEs. It also significantly reduced the time required for dose calculation, prescription generation, and electronic documentation of medical records, compared with the traditional handwritten approach.
Keywordselectronic prescribing - decision support system - medication errors - neonates - patient safety - workflow efficiency
The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.
The study protocol was approved by the Institutional Review Board Blind (Ref: Blind). The relevant procedures were carried in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) as well as with the principles of Good Clinical Practice issued by the Declaration of Helsinki (2004, Tokyo) and its later amendments. Informed consent was obtained from the participants' parents before inclusion in the study.
E.F.B. conceived the presented idea and supervised the project. E.F.B., A.B., A.D., M.A.-L., L.M., A.M., and A.T. planned the project. M.A.-T. supervised and participated in the design and development of the technical aspects of the developed NPHCS. A.M. and A.T. designed the research tools. H.S. and A.T. reviewed the NMPE of the pre-CPOE part. A.A.-T. helped with project supervision and training the health care professionals. A.A.-T. and M.J. carried out the project and contributed to the interpretation of the results. E.B., A.A.-T., and M.A.-T. took the lead in writing the manuscript. All authors provided critical feedback, participated in the research and analysis, and contributed to the final manuscript.
Received: 12 March 2020
Accepted: 09 October 2020
12 January 2021 (online)
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