Title: Evaluation of a Computerized Prescriber Order Entry Program for Antibiotics in the Neonatal Intensiv
1Evaluation of a Computerized Prescriber Order
Entry Program for Antibiotics in the Neonatal
Intensive Care Unit
- Lizbeth Hansen, Pharm.D.
- Pharmacy Practice Resident
- Preceptors Sandra Garner, Pharm.D.
- Toby Cox Pharm.D.
2Pediatric Medication Errors
- Childrens risk for potential adverse drug events
(ADEs) nearly triple those in adult patients - Rate is significantly higher neonates
- 28 of potential ADEs involved anti-infective
drugs
Kaushal R. Medication errors and adverse drug
events in pediatric inpatients. JAMA.
20012852114-2120.
3Pediatric Medication Errors
- ADEs by stage of error
- Physician ordering 74
- Transcribing 10
- Nurse administration 13
- Pharmacy dispensing lt1
- Patient monitoring lt1
- 64.4 of medication errors considered preventable
with computerized physician order entry (CPOE) - 43 of potentially harmful errors
Kaushal R. Medication errors and adverse drug
events in pediatric inpatients. JAMA.
20012852114-2120. Bobb A. The epidemiology of
prescribing errors. Arch Int Med.
2004164785-792.
4Purpose
- Determine effect of CPOE program on the rate of
prescribing errors for antibiotics in the NICU
for late onset neonatal sepsis
5Late Onset Neonatal Sepsis
- Onset beyond 72 hours of life
- Organisms responsible for bloodstream infections
- Coagulase-negative staphylococci 48.3
- Enterococci 15.5
- Non-albicans fungi 10.3
- Candida albicans 6.9
- Pseudomonas aeruginosa 5.2
- Serratia marcescens 3.4
- Escherichia coli 3.4
- Staphylococcus Aureus 3.4
- Klebsiella pneumoniae 1.7
- Other bacteria 1.7
Sohn AH. Prevalence of nosocomial infections in
neonatal intensive care unit patients Results
from the first national point-prevalence
survey. J Pediatr. 2001139821-827.
6Late Onset Neonatal Sepsis
- Risk factors for acquisition of infections in
NICU - Gestational age
- Postnatal age
- Birth weight
- Total parenteral nutrition
- Central venous catheter use
- Mechanical ventilation
Sohn AH. Prevalence of nosocomial infections in
neonatal intensive care unit patients Results
from the first national point-prevalence
survey. J Pediatr. 2001139821-827.
7Emperic Treatment of LOS
- Vancomycin Piperacillin/tazobactam
- Hemodynamically unstable
- Central line 10 days
- Nafcillin Gentamicin
- Hemodynamically stable
- Central line lt 10 days
- Add antifungal
- Birth weight 1,000g
- Thrombocytopenia or significant drop in platelet
count - Frequent or prolonged antibiotic use
MUSC Recommendation of Task Force Evaluation and
Treatment of Nosocomial Sepsis. Revised 6/28/04.
8Neonatal Late Onset Sepsis Evaluation Orders
9Neonatal Late Onset Sepsis Evaluation Orders
10Methods
11Methods
- Orders assessed for
- MUSC required elements of pediatric orders
Patient name, date of birth, medical record
number, date and time, weight, medication name,
dose, dosage units, dosage calculation (based on
mg/kg), route, frequency/interval, signature and
pager, no prohibited abbreviations - Appropriate dose, route, schedule, choice of
antibiotics - Drug-drug or drug-disease state interaction,
contraindications
12Pre-CPOE Results
2.6 orders were missing critical data
13Pre-CPOE Results
14Pre-CPOE Results
15Limitations
- Potential for missing orders
- Always potential for pharmacist intervention
- Classification of medication errors requires
clinical judgment - Prescribers aware of study progress
- May not be generalizable to non-academic hospital
- Some debate in literature
- Late onset neonate sepsis 48 hr vs 72 hr of life
- The choice of emperic antimicrobials
16Conclusions
- Significant rate of medication errors in our NICU
- Missing information
- Error prone schedule abbreviation
- Not ordered STAT
17Questions?