Preventing Provider Errors: Online Total Parenteral Nutrition Calculator
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* Division of Neonatology, Department of Pediatrics, and Division of Health Sciences Informatics, Johns Hopkins University, Baltimore, Maryland
Division of Pediatric Pharmacy, Johns Hopkins Hospital, Baltimore, Maryland
Division of Pediatric Gastroenterology/Nutrition, Johns Hopkins Hospital, Baltimore, Maryland
Objective. To describe the development of a pragmatic low-cost medical information system that reduces errors in the ordering of total parenteral nutrition (TPN) in the newborn intensive care unit at the Johns Hopkins Hospital.
Methods. We designed an online total parenteral nutrition order entry system (TPNCalculator) using Internet technologies. Utilization, impact on medical errors, and user satisfaction were evaluated prior to and immediately after introduction of TPNCalculator (intervention 1) and after 2 years (intervention 2).
Results. Total software development time was 3 weeks. The number of orders was similar during the 3 periods: 0.39 orders per patient per day (N = 557) were received compared with 0.35 and 0.43 orders per patient per day (N = 471 and N = 656) in 2 intervention periods. During the control period, an average of 10.8 errors were detected per 100 TPN orders compared with 4.2 per 100 orders in the first intervention period (61% reduction of error rate) and 1.2 per 100 orders after 2 years and some redesign of TPNCalculator (89% reduction of error rate). We found a reduction in the following types of problems (intervention 1; intervention 2): calculation errors (100%; 100%), osmolality outside the allowed range (88%; 91%), and other knowledge problems (84%; 100%). There was a 35% increase in the number of incomplete forms in the first intervention period and a 100% reduction in the second. Rapid cycle development was used in the development of this application. Users of the system were enthusiastic and supportive and compared it favorably to the previous paper-based system.
Conclusion. Low-cost, pragmatic approaches using Internet technology in the design of medical information systems can reduce medical errors and might pose a viable option for the prevention of adverse drug events.
Key Words: medication errors/classification • medication systems • hospital/organization and administration • software design • medical informatics computing
Abbreviations: ADE, adverse drug event • NICU, neonatal intensive care unit • TPN, total parenteral nutrition • JHH, Johns Hopkins Hospital
Received for publication Jan 21, 2003; Accepted Jul 25, 2003.
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