Computerized PN ordering optimizes timely nutrition therapy in a neonatal intensive care unit

Objective. To determine whether automation could accelerate the parenteral nutrition (PN) ordering and delivery process with concurrent improvements in the quality of nutrition therapy. Design. The time required to order, process, and deliver PN orders and specific nutrient composition of the PN solution were collected prospectively for 2 weeks on all neonatal intensive care unit (NICU) patients receiving PN during both the manual phase (before automation) and computer phase of the study. Subjects/Setting. A total of 81 newborn infants in the NICU receiving PN for more than 5 days completed the study. Statistical analyses. Student's unpaired t test was used to evaluate differences between computer and manual methods for all outcome variables of interest. Results. The time required to write and deliver PN orders was significantly lower using computer rather than manual methods (1.4+/-0.2 vs 4.5+/-0.5 minutes; P=.0001). Significant improvements in the nutrient composition of the PN solution resulted from use of computer ordering for energy (93.4+/-1.48 vs 79.2+/-1.8 kcal/kg per day; P=.0001), protein (2.92+/-0.02 vs 2.7+/-0.03 g protein per kilogram per day: P=.0001), calcium (2.3+/-0.1 vs 1.8+/-0.1 mEq/kg per day; P=.0005), and phosphate (1.3+/-0.06 vs 0.9+/-0.06 mM/kg per day; P=.0001). In addition, alkaline phosphatase levels improved (272+/-11 vs 404+/-25 U/L; P=.0001) and caloric and protein goals were achieved sooner (5.9+/-0.4 vs 8.7+/-0.8 days; P=.0045) when computer ordering rather than the manual method of ordering PN was used. Implications. Our findings indicate that automating the process of writing and delivering PN orders saved time because it eliminated repetitive tasks and tedious calculations previously required of neonatologists, dietitians, and pharmacists. Patient care in our population of neonates was enhanced by improving the nutrient content of the PN solution.