Implementation of computerized provider order entry in a neonatal intensive care unit: Impact on admission workflow

ObjectiveThe study objective was to determine if computerized provider order entry (CPOE) systems impaired or enhanced workflow in the neonatal intensive care unit (NICU) by comparing the timing of administration of the first dose of antibiotics before and after CPOE system implementation.MethodsWe conducted a pre-post intervention comparative study of the length of time between admission and administration of initial antibiotics in neonates before and after a CPOE system was implemented. Clinical information and timing of antibiotic administration were collected on all inborn infants, who were admitted to the NICU in the first 4 h of life and treated with antibiotics, for one year prior to the implementation of computerized order entry and for one year after the implementation.ResultsInfants admitted to the NICU were similar in both periods (mean birth weight 2183 g vs. 2091 g, gestational age 33.3 weeks vs. 33.0 weeks). There was no significant difference in mean length of time from admission to antibiotic administration in the pre-CPOE group (131 min [CI 124–139]) compared to the post-CPOE group (125 min [CI 116–133]) (p = 0.07). The mean time to pharmacy verification for a subset of patients was significantly shorter for patients in the post-CPOE group (61 ± 58 min) compared to the pre-CPOE group (88 ± 76 min) (p = <0.001).ConclusionsWhile the introduction of a CPOE system in the NICU did not significantly improve antibiotic administration times, the timeliness of an important aspect of the medication process, time to pharmacy verification, was improved. These findings imply other factors are impeding workflow. Further studies are needed to evaluate how CPOE systems combined with patient care activities affect workflow and overall patient care.

► Introduction of CPOE improved pharmacy turnaround times.
► Despite improved pharmacy turnaround, there was no change in the time to the first dose of antibiotics.
► Admission workflow is a complex process, and will require a multifaceted approach in order to further improve antibiotic administration time in the neonatal intensive care unit.