A Computer Prescribing Order Entry–Clinical Decision Support system designed for neonatal care: results of the ‘preselected prescription’ concept at the bedside

Abstract : What is knownăThe neonatal intensive care units (NICUs) are at the highest risk of drug dose error of all hospital wards. NICUs also have the most complicated prescription modalities. The computerization of the prescription process is currently recommended to decrease the risk of preventable adverse drug effects (pADEs) in NICUs. However, Computer Prescribing Order Entry–Clinical Decision Support (C.P.O.E./C.D.S.) systems have been poorly studied in NICUs, and their technical compatibility with neonatal specificities has been limited.ăObjectivesăWe set up a performance study of the preselected prescription of drugs for neonates, which limited the role of the prescriber to choosing the drugs and their indications.ăMethodsăA single 29 bed neonatal ward used this neonatal C.P.O.E./C.D.S. system for all prescriptions of all hospitalized newborns over an 18-month period. The preselected prescription of drugs was based on the indication, gestational age, body weight and post-natal age. The therapeutic protocols were provided by a formulary reference (330 drugs) that had been specifically designed for newborns. The preselected prescription also gave complete information about preparation and administration of drugs by nurses. The prescriber was allowed to modify the preselected prescription but alarms provided warning when the prescription was outside the recommended range. The main clinical characteristics and all items of each line of prescription were stored in a data warehouse, thus enabling this study to take place.ăResultsăSeven hundred and sixty successive newborns (from 24 to 42 weeks’ gestation) were prescribed 52 392 lines of prescription corresponding to 65 drugs; About 30·4% of neonates had at least one out of licensed prescription; A prescription out of the recommended range for daily dose was recorded for 1·0% of all drug prescriptions.ăWhat is new?ăThe C.P.O.E./C.D.S. systems can currently provide a complete preselected prescription in NICUs according to dose rules, which are specific to newborns and also comply with local specificities (therapeutic protocols and formulation of drugs). The role of the prescriber is limited to the choice of drugs and their indications. The prescriber still retains the possibility of modifying each item of the prescription, with all other prescription items being calculated by the C.P.O.E. system. In these conditions, the prescribers rarely modified the preselected prescription and the rate of out of range prescription was low. A multicentric study is required to confirm and extend these observations.ăConclusionsăThis study showed the feasibility of preselected prescription in NICUs and a low rate of out of range prescriptions. The preselected prescription could play a key role in lowering the dose error rate in NICUs.
Type de document :
Article dans une revue
Journal of Clinical Pharmacy and Therapeutics, Wiley, 2017, 42 (1), pp.64--68. 〈10.1111/jcpt.12474〉
Liste complète des métadonnées

Littérature citée [21 références]  Voir  Masquer  Télécharger

http://hal.univ-reunion.fr/hal-01476991
Contributeur : Réunion Univ <>
Soumis le : mardi 14 novembre 2017 - 08:06:37
Dernière modification le : vendredi 14 septembre 2018 - 08:15:45
Document(s) archivé(s) le : jeudi 15 février 2018 - 12:38:54

Fichier

2017 Gouyon B. A Computer Pres...
Fichiers produits par l'(les) auteur(s)

Identifiants

Collections

Citation

B. Gouyon, Silvia Iacobelli, E. Saliba, Catherine Quantin, A. Pignolet, et al.. A Computer Prescribing Order Entry–Clinical Decision Support system designed for neonatal care: results of the ‘preselected prescription’ concept at the bedside. Journal of Clinical Pharmacy and Therapeutics, Wiley, 2017, 42 (1), pp.64--68. 〈10.1111/jcpt.12474〉. 〈hal-01476991〉

Partager

Métriques

Consultations de la notice

70

Téléchargements de fichiers

33