Provider error prevention: Online total parenteral nutrition calculator

Objective: 1. To reduce errors in the ordering of total parenteral nutrition (TPN) in the Newborn Intensive Care Unit (NICU) at the Johns Hopkins Hospital (JHH). 2. To develop a pragmatic low-cost medical information system to achieve this goal. Methods: We designed an online total parenteral nutrition order entry system (TPNCalculator) using Internet technologies. Total development time was three weeks. Utilization, impact on medical errors and user satisfaction were evaluated. Results: During the control period, 0.39 orders per patient per day (N=557) were received compared to 0.35 orders per patient per day (N=471) in the intervention period (NS). There was no significant difference in the percentage of late (incomplete by order deadline) TPN orders. During the control period, an average of 10.8 errors were detected per 100 TPN orders compared to 4.2 per 100 orders in the intervention period (61% reduction of error rate; p < 0.01). We found a reduction in the following types of problems: Calculation errors (100%), osmolality issues (87%) and other knowledge problems (84%). There was a 35% increase in the number of incomplete forms. Users of the system were enthusiastic and supportive and compared it favorably to the prior paper based system. Conclusion: Low-cost, pragmatic approaches utilizing 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.