The Experts below are selected from a list of 10842 Experts worldwide ranked by ideXlab platform
Hagop S Mekhjian - One of the best experts on this subject based on the ideXlab platform.
-
impact of computerized physician order entry on clinical practice in a Newborn Intensive Care unit
Journal of Perinatology, 2004Co-Authors: Leandro Cordero, Lynn Kuehn, Rajee R Kumar, Hagop S MekhjianAbstract:Impact of Computerized Physician Order Entry on Clinical Practice in a Newborn Intensive Care Unit
-
impact of computerized physician order entry on clinical practice in a Newborn Intensive Care unit
Journal of Perinatology, 2004Co-Authors: Leandro Cordero, Lynn Kuehn, Rajee R Kumar, Hagop S MekhjianAbstract:OBJECTIVE: To study the impact of computerized physician order entry (CPOE) on selected neonatal Intensive Care unit (NICU) practices. DESIGN: Retrospective review. SETTING: Nursing units in an academic health system where CPOE has been implemented in adult services since 2000 and in the NICU since 2002. STUDY POPULATION: Data from 111 very-low-birth-weight (VLBW) infants born consecutively within 6 months before and 100 VLBW infants born within 6 months after the implementation of CPOE were evaluated. The study is based on pre- and post-CPOE comparisons in medication error rates and on the initiation to completion time intervals for pharmacy orders and radiology procedures. The specific data subsets that were compared included caffeine and gentamicin. Radiology turn-around time (order to image display) for the first chest and abdominal X-ray taken following endotracheal intubation and/or umbilical catheter placement was studied. RESULTS: Statistically significant (p<0.01) reductions were seen in medication turn-around times for the loading dose of caffeine in pre-CPOE (n=41, mean 10.5±9.8 SD hours) and post-CPOE (n=48, mean 2.8±3.3 SD hours). After CPOE implementation, the percentage of cases during each period where caffeine was administered before 2 and 3 hours increased from 10 to 35% and 12 to 63%, respectively. Accuracy of gentamicin dose at the time of admission for 105 (pre-CPOE) and 92 (post-CPOE) VLBW infants was determined. In the pre-CPOE period, 5% overdosages, 8% underdosages, and 87% correct dosages were identified. In the post-CPOE, no medication errors occurred. Accuracy of gentamicin dosages during hospitalization at the time of suspected late-onset sepsis for 31 pre- and 28 post-CPOE VLBW infants was studied. Gentamicin dose was calculated incorrectly in two of 31 (6%) pre-CPOE infants. No such errors were noted in the post-CPOE period. Radiology response time decreased significantly from the pre-CPOE (n=107, mean 42±12 SD minutes) to post-CPOE (n=95, mean 32±16 SD minutes). CONCLUSION: The implementation of CPOE in our NICU resulted in a significant reduction in medication turn-around times and medication errors for selected drugs, and a decrease in ancillary service (radiology) response time. In spite of the complexities of medication orders in pediatric populations, commercially available software programs for CPOE can successfully be adjusted to accommodate NICU needs and to beneficially impact clinical practice.
Leandro Cordero - One of the best experts on this subject based on the ideXlab platform.
-
impact of computerized physician order entry on clinical practice in a Newborn Intensive Care unit
Journal of Perinatology, 2004Co-Authors: Leandro Cordero, Lynn Kuehn, Rajee R Kumar, Hagop S MekhjianAbstract:Impact of Computerized Physician Order Entry on Clinical Practice in a Newborn Intensive Care Unit
-
impact of computerized physician order entry on clinical practice in a Newborn Intensive Care unit
Journal of Perinatology, 2004Co-Authors: Leandro Cordero, Lynn Kuehn, Rajee R Kumar, Hagop S MekhjianAbstract:OBJECTIVE: To study the impact of computerized physician order entry (CPOE) on selected neonatal Intensive Care unit (NICU) practices. DESIGN: Retrospective review. SETTING: Nursing units in an academic health system where CPOE has been implemented in adult services since 2000 and in the NICU since 2002. STUDY POPULATION: Data from 111 very-low-birth-weight (VLBW) infants born consecutively within 6 months before and 100 VLBW infants born within 6 months after the implementation of CPOE were evaluated. The study is based on pre- and post-CPOE comparisons in medication error rates and on the initiation to completion time intervals for pharmacy orders and radiology procedures. The specific data subsets that were compared included caffeine and gentamicin. Radiology turn-around time (order to image display) for the first chest and abdominal X-ray taken following endotracheal intubation and/or umbilical catheter placement was studied. RESULTS: Statistically significant (p<0.01) reductions were seen in medication turn-around times for the loading dose of caffeine in pre-CPOE (n=41, mean 10.5±9.8 SD hours) and post-CPOE (n=48, mean 2.8±3.3 SD hours). After CPOE implementation, the percentage of cases during each period where caffeine was administered before 2 and 3 hours increased from 10 to 35% and 12 to 63%, respectively. Accuracy of gentamicin dose at the time of admission for 105 (pre-CPOE) and 92 (post-CPOE) VLBW infants was determined. In the pre-CPOE period, 5% overdosages, 8% underdosages, and 87% correct dosages were identified. In the post-CPOE, no medication errors occurred. Accuracy of gentamicin dosages during hospitalization at the time of suspected late-onset sepsis for 31 pre- and 28 post-CPOE VLBW infants was studied. Gentamicin dose was calculated incorrectly in two of 31 (6%) pre-CPOE infants. No such errors were noted in the post-CPOE period. Radiology response time decreased significantly from the pre-CPOE (n=107, mean 42±12 SD minutes) to post-CPOE (n=95, mean 32±16 SD minutes). CONCLUSION: The implementation of CPOE in our NICU resulted in a significant reduction in medication turn-around times and medication errors for selected drugs, and a decrease in ancillary service (radiology) response time. In spite of the complexities of medication orders in pediatric populations, commercially available software programs for CPOE can successfully be adjusted to accommodate NICU needs and to beneficially impact clinical practice.
Heidelise Als - One of the best experts on this subject based on the ideXlab platform.
-
Physiological and emotional effects of pentatonic live music played for preterm neonates and their mothers in the Newborn Intensive Care Unit : a randomized controlled trial
Complementary therapies in medicine, 2018Co-Authors: A. Ranger, Eduard Helmert, T.s. Bott, Thomas Ostermann, Heidelise Als, D Bassler, Martin Hautzinger, Jan VagedesAbstract:Abstract Objective Despite attempts to increase calmness in the Newborn Intensive Care Unit (NICU), preterm neonates still experience stress. The question arises how to further promote the infants’ wellbeing. Therefore, the immediate effects of pentatonic live music on preterm infants and their mothers were examined. Design and methods In a two-centre randomized controlled trial with crossover design preterm infants were exposed sequentially to two conditions: live pentatonic harp music (LPHM) used in Anthroposophic Medicine or standard Care. The order of the conditions was randomized within each subject. The primary outcome was change of the number of oxygen desaturations Results 21 preterm infants were randomized (14 girls), mean gestational age at measurement 35 + 0 weeks (SD 1 week). The primary outcome parameter showed no significant changes. Regarding the secondary outcomes the comparison of the pre-post-differences between the conditions showed significant effects for the HRV parameters pNN50 (ΔpNN50 = 1.46%, z = −2.47, p = .001) and SDNN (ΔSDNN=−0.06 ms, z = −2.25, p = .002). The music intervention significantly increased the values of pNN50 (Mdn 1.2% vs. 2.6%, p = 0.04) and marginally those of SDNN (Mdn 31.7 ms vs. 36.4 ms, p = 0.05). No changes were found in the other parameters. Conclusions While the use of music in the NICU had no effect on the number of oxygen desaturations, it increased two HRV parameters indicative of infants’ parasympathetic tone.
-
developmental Care in the Newborn Intensive Care unit
Current Opinion in Pediatrics, 1998Co-Authors: Heidelise AlsAbstract:Developmental Care is a framework that encompasses all Care procedures as well as social and physical aspects in the Newborn Intensive Care unit. Its goal is to support each individual infant to be as stable, well-organized, and competent as possible. The infant's physiologic and behavioral expression of current functioning is seen as the reliably available guide for Caregivers to estimate the infant's current strengths, vulnerabilities, and thresholds to disorganization; to identify the infant's own strategies and efforts in collaborating toward best progress; and to implement Care in a way that enhances the infant's stability and competence. The family is understood to be the infant's primary coregulator. It is the Caregivers' responsibility to maximize opportunities to enhance each infant's and family's strengths and reduce apparent stressors. Studies of the effectiveness of developmental Care also identify implications for staff education and challenges for nursery-wide implementation.
-
the role of relationship based developmentally supportive Newborn Intensive Care in strengthening outcome of preterm infants
Seminars in Perinatology, 1997Co-Authors: Heidelise Als, Linda GilkersonAbstract:This article details the conceptual framework, clinical application, and efficacy of a relationship-based developmentally supportive approach to Newborn Intensive Care referred to as NIDCAP (Newborn Individualized Developmental Care and Assessment Program). Outcomes of the approach are reported in regard to infant health and development, reduction of hospital costs, and family adaptation. The approach is guided by a neurodevelopmental framework for understanding preterm infants and depends on the capacities of professionals to collaborate with one another and with families in support of the infants' medical, developmental, and emotional well-being. The primary vehicle for clinical implementation is detailed behavioral observation with subsequent recommendations for individualized Caregiving based on the infant's current functioning and apparent developmental goals. A series of essential components of developmentally oriented Caregiving are described, including strategies for coordinated discharge planning, and linkage to community services. The voices of individual clinicians highlight the process of change from protocol-based to relationship-based Care.
-
effectiveness of individualized neurodevelopmental Care in the Newborn Intensive Care unit nicu
Acta Paediatrica, 1996Co-Authors: Heidelise Als, Frank H Duffy, Gloria B McanultyAbstract:The individual infant's neurodevelopmental process provides an integrative framework for the delivery of medical Care needed to assure the infant's survival and quality of outcome. The infant's neurobehavioral functioning and expression provides an opportunity for Caregivers to estimate the individual infant's current strengths, vulnerabilities and threshold to disorganization, as well as to identify the infant's strategies in collaborating in his or her best progression. This perspective supports Caregivers in seeing themselves in a relationship with the infant, and in considering opportunities to enhance the infant's strengths and reduce apparent stressors in collaboration with the infant and the family. The results of several randomized studies supporting the effectiveness of such a neuro developmental approach to NICU Care will be presented, and suggest implications for staff education and nursery-wide implementation.
-
role of reflective process in the implementation of developmentally supportive Care in the Newborn Intensive Care nursery
Infants and Young Children, 1995Co-Authors: Linda Gilkerson, Heidelise AlsAbstract:The National Collaborative Research Institute on Early Childhood Intervention (NCRI-ECI) multisite study of the effectiveness of family-focused, developmentally supportive Care with low birthweight infants consisted of an experimental component and a reflective process component. This article descri
Robert D White - One of the best experts on this subject based on the ideXlab platform.
-
the Newborn Intensive Care unit environment of Care how we got here where we re headed and why
Seminars in Perinatology, 2011Co-Authors: Robert D WhiteAbstract:The Newborn Intensive Care unit (NICU) is a life-defining place for many infants, families, and Caregivers. The place in which such events occur is often remembered for its sights, sounds, and smells, but the physical environment of the NICU is far more than a memory tag; it can directly influence the quality of the experience for all of its inhabitants. A growing body of evidence demonstrates the profound impact of the physical environment on growth and development of the neonatal brain. The value of skin-to-skin Care is now established. Psychology, sociology, and occupational health provide additional insight into the effect of the NICU setting on families and Caregivers. Together, these lines of evidence point to the need for individualized environments. Single-family rooms are a growing trend in the NICU because they allow for individualized environments. Careful planning can avoid pitfalls and bring benefit to babies, families, and Caregivers alike.
-
are surveillance of resistant enteric bacilli and antimicrobial usage among neonates in a Newborn Intensive Care unit useful
Pediatrics, 2009Co-Authors: Robert D White, T R Townsend, M A Stephens, E R MoxonAbstract:From March 1976 through December 1978, the prevalence of ampicillin- and gentamicin-resistant enteric bacilli was monitored in fecal cultures of neonates in an Intensive Care unit. Substantial fluctuations in colonization rates were observed which did not correlate with the occurrence of sepsis due to these organisms nor with variations in antibiotic use. This experience suggests that the availability of these surveillance data did not result in more effective control of neonatal sepsis due to enteric bacilli.
-
room for improvement nurses perceptions of providing Care in a single room Newborn Intensive Care setting
Advances in Neonatal Care, 2006Co-Authors: William F Walsh, Kristin L Mccullough, Robert D WhiteAbstract:Theoretically, single patient room Newborn Intensive Care units are designed to optimize the developmental outcomes of critically ill infants by providing individual patient environments with decreased stimulation and noise. This article reports the perceptions of 127 neonatal Intensive Care nurses after the move into a single room neonatal Intensive Care unit (NICU). The observations of the nurses were obtained using a questionnaire to identify some of the benefits, risks, and specific patient safety concerns related to the single room NICU design. The results suggest that in this setting the single patient room concept was deemed superior for patient Care and parent satisfaction when compared to the large open unit. However, the nurses emphasize that the success of single room Care model primarily depends on providing sufficient staff coverage, given the decreased patient visibility and greater distances between patients. Larger units also present unique communication, staff education, and quality improvement challenges. To further evaluate the impact of single room designs we evaluated data on important clinical issues, specifically noise levels and catheter-related infections provide objective measures of important improvements. Noise levels decreased from an average of 63 to 56 decibels and catheter-associated bloodstream infections fell from 10.1 per 1000 device days to 3.3 per 1000 device days in the 9 months after the move to single patient rooms. This article provides pragmatic design suggestions that should be prospectively considered to minimize staff isolation and stress.
Lynn Kuehn - One of the best experts on this subject based on the ideXlab platform.
-
impact of computerized physician order entry on clinical practice in a Newborn Intensive Care unit
Journal of Perinatology, 2004Co-Authors: Leandro Cordero, Lynn Kuehn, Rajee R Kumar, Hagop S MekhjianAbstract:Impact of Computerized Physician Order Entry on Clinical Practice in a Newborn Intensive Care Unit
-
impact of computerized physician order entry on clinical practice in a Newborn Intensive Care unit
Journal of Perinatology, 2004Co-Authors: Leandro Cordero, Lynn Kuehn, Rajee R Kumar, Hagop S MekhjianAbstract:OBJECTIVE: To study the impact of computerized physician order entry (CPOE) on selected neonatal Intensive Care unit (NICU) practices. DESIGN: Retrospective review. SETTING: Nursing units in an academic health system where CPOE has been implemented in adult services since 2000 and in the NICU since 2002. STUDY POPULATION: Data from 111 very-low-birth-weight (VLBW) infants born consecutively within 6 months before and 100 VLBW infants born within 6 months after the implementation of CPOE were evaluated. The study is based on pre- and post-CPOE comparisons in medication error rates and on the initiation to completion time intervals for pharmacy orders and radiology procedures. The specific data subsets that were compared included caffeine and gentamicin. Radiology turn-around time (order to image display) for the first chest and abdominal X-ray taken following endotracheal intubation and/or umbilical catheter placement was studied. RESULTS: Statistically significant (p<0.01) reductions were seen in medication turn-around times for the loading dose of caffeine in pre-CPOE (n=41, mean 10.5±9.8 SD hours) and post-CPOE (n=48, mean 2.8±3.3 SD hours). After CPOE implementation, the percentage of cases during each period where caffeine was administered before 2 and 3 hours increased from 10 to 35% and 12 to 63%, respectively. Accuracy of gentamicin dose at the time of admission for 105 (pre-CPOE) and 92 (post-CPOE) VLBW infants was determined. In the pre-CPOE period, 5% overdosages, 8% underdosages, and 87% correct dosages were identified. In the post-CPOE, no medication errors occurred. Accuracy of gentamicin dosages during hospitalization at the time of suspected late-onset sepsis for 31 pre- and 28 post-CPOE VLBW infants was studied. Gentamicin dose was calculated incorrectly in two of 31 (6%) pre-CPOE infants. No such errors were noted in the post-CPOE period. Radiology response time decreased significantly from the pre-CPOE (n=107, mean 42±12 SD minutes) to post-CPOE (n=95, mean 32±16 SD minutes). CONCLUSION: The implementation of CPOE in our NICU resulted in a significant reduction in medication turn-around times and medication errors for selected drugs, and a decrease in ancillary service (radiology) response time. In spite of the complexities of medication orders in pediatric populations, commercially available software programs for CPOE can successfully be adjusted to accommodate NICU needs and to beneficially impact clinical practice.