Computerized Physician Order Entry (CPOE) in pediatric and neonatal intensive care

I Castellanos; G Rellensmann; J Scharf; T Bürkle

doi:10.4338/ACI-2011-08-RA-0051

Applied Clinical Informatics, Table of Contents

Appl Clin Inform 2012; 03(01): 64-79
DOI: 10.4338/ACI-2011-08-RA-0051

Research Article

Schattauer GmbH

Computerized Physician Order Entry (CPOE) in pediatric and neonatal intensive care

Recommendations how to meet clinical requirements

I Castellanos

¹Anästhesiologische Klinik, Universitätsklinikum Erlangen, Germany

,

G Rellensmann

²Klinik und Poliklinik für Kinder- und Jugendmedizin, Allgemeine Pädiatrie, Universitätsklinikum Münster, Germany

,

J Scharf

³Kinder- und Jugendklinik, Universitätsklinikum Erlangen, Germany

,

T Bürkle

⁴Lehrstuhl für Medizinische Informatik, Universität Erlangen-Nürnberg, Germany

› Author Affiliations

Abstract

Summary

Objective: To identify and summarize the requirements of an optimized CPOE application for pediatric intensive care.

Methods: We analyzed the medication process and its documentation in the pediatric and neonatal intensive care units (PICU/NICU) of two university hospitals using workflow analysis techniques, with the aim of implementing computer-supported physician order entry (CPOE).

Results: In both PICU/NICU, we identified similar processes that differed considerably from adult medication routine. For example, both PICU/NICU prepare IV pump syringes on the ward, but receive individualized ready-to-use mixed IV bags for each patient from the hospital pharmacy on the basis of a daily order. For drug dose calculation, both PICU/NICU employ electronic calculation tools that are either incorporated within the CPOE system, or are external modules invoked via interface.

Conclusion: On the basis of this analysis, we provide suggestions to optimize CPOE applications for use in the pediatric and neonatal intensive care unit in the form of three catalogues of desiderata for drug order entry support.

Keywords

Inpatient - inpatient CPOE - critical care and emergency - pediatrics - neonatology - clinical documentation and communications - requirements analysis and design - intensive care - workflow

Full Text

References

References
1 Bürkle T, Castellanos I, Tech H, Prokosch HU. Implementation of a patient data management system –an evaluation study of workflow alterations. Stud Health Technol Inform 2010; 160: 1256-1260.
2 Castellanos I, Bürkle T, Prokosch HU, Schüttler J. Konzept zur flächendeckenden Einführung eines Patientendatenmanagementsystems am Großklinikum –eine interdisziplinäre Herausforderung. Anästh Intensivmed 2009; 50: 618-629.
3 Gerken W. Systemanalyse –Entwurf und Auswahl von DV-Anwendersystemen. Bonn: Addison-Wesley Publishing Company; 1988
4 Han YY, Carcillo JA, Venkataraman ST. Unexpected increased mortality after implementation of a commercially sold computerized physician order entry system. Pediatrics 2005; 116: 1506-1512.
5 Hripscak G, Ludemann P, Pryor TA, Wigertz OB, Clayton PD. Rationale for the Arden Syntax. Computers and Biomedical Research 1994; 27: 291-324.
6 Jochum F. editor. Infusionstherapie und Diätetik in der Pädiatrie. Heidelberg: Springer Medizinverlag; 2005
7 Kadmon G, Bron-Harlev E, Nahum E, Schiller O, Haski G, Shonfeld T. Computerized order entry with limited decision support to prevent prescription errors in a PICU. Pediatrics 2009; 124 (03) 935-940.
8 Kaushal R, Bates DW, Landrigan C. Medication errors and adverse drug events in pediatric Iinpatients. JAMA 2001; 285 (16) 2114-2120.
9 Kaushal R, Shojania KG, Bates DW. Effects of computerized physician order entry and clinical decision support systems on medication safety –a systematic review. Arch Intern Med 2003; 163: 1409-1416.
10 Kaushal R, Barker KN, Bates DW. How can information technology improve patient safety and reduce medication errors in children´s health care?. Arch Pediatr Adolesc Med 2001; 155 (09) 1002-1007.
11 Kohn LT, Corrigan JM. Donaldson MS; Committee on quality of health care in America, Institute of Medicine. To err is human: building a safer health system. National Academic Press; 2000
12 Koppel R, Metlay JP, Cohen A. Role of computerized physician order entry systems in facilitating medication errors. JAMA 2005; 293: 1197-1203.
13 Kuhn KA, Lenz R, Elstner T, Siegele H, Moll R. Experiences with a generator tool for building clinical application modules. Methods Inf Med 2003; 42 (01) 37-44.
14 Lenz R, Kuhn KA. Towards a continuous evolution and adaptation of information systems in healthcare. Int J Med Inform 2004; 73: 75-89.
15 Longhurst CA, Parast L, Sandborg CI. Decrease in hospital-wide mortality rate after implementation of a commercially sold computerized physician order entry system. Pediatrics 2010; 126 (01) 14-21.
16 Nicolai T. Pädiatrische Notfall- und Intensivmedizin: Ein praktischer Leitfaden.1st ed. Heidelberg: Springer Medizin Verlag; 2007
17 Pomberger G. Softwaretechnik und Modula 2., 2nd ed. Munich: Karl Hanser Verlag; 1987
18 Smith J. UK Department of Health. Building a safer NHS for patients –improving medication safety. UK Department of Health 2004: 1-173.
19 Valentin A, Capuzzo M, Guidet B, Moreno R, Metnitz B, Bauer P. et al. Errors in administration of parenteral drugs in intensive care units: multinational prospective study. BMJ 2009; 338: b814.
20 Vardi A, Efrati O, Levin I. Prevention of potential errors in resuscitation medications orders by means of a computerised physician order entry in pediatric critical care. Resuscitation 2007; 73: 400-406.