Using Workflows and Technologies to Improve Patient Safety and Reduce Nurse Burnout

Data evaluating the frequency and occurrence of calculation errors in infant feeding preparation is difficult to find as healthcare facilities may not have systems in place to identify such errors.⁶  If a manual calculation error occurs, resulting in the improper preparation of human milk or formula, the person preparing the feeding may never be aware of the error.  If the calculation error is identified before feeding preparation, the error is most likely corrected but not necessarily reported anywhere as a “near miss.”  However, a review of the literature regarding medication calculation errors may provide some insight.  Research on medication dosage errors has shown that such errors pose a tremendous patient safety risk and may result in morbidity or even death.⁹  In fact, a 2008 Sentinel Event Alert from The Joint Commission (TJC) noted that pediatric patients were at increased risk of medical errors due to “specialized dosing needs that may require calculations by nurses or pharmacists.” ¹⁰ Unfortunately, dose calculation errors likely occur on a fairly regular basis.¹¹  A five-year study in an Australian children’s hospital found that 341 of the 3,340 recorded medication errors were related to miscalculations.¹¹ Strong math skills and calculation safeguards may have reduced the likelihood of these preventable errors.

In the context of infant feedings, recipe calculation errors may result in improper human milk or formula preparation which, in turn, can have serious health consequences.^{7, 12-13}  Administering incorrect fortifier or formula quantities may result in under- or over-feeding, allergic reactions, feeding intolerance, and metabolic or electrolyte disturbances.¹³

While preventable, miscalculations can and do occur because of human error.  Consequently, healthcare organizations should adopt processes which ensure guardrails are in place to minimize risk of human error and protect patient safety.  Fortunately, the use of technology in the preparation of infant feedings has become increasingly more common, particularly as an effort to reduce risk of using incorrect, expired, or recalled products and to track product lot numbers.⁷  Support for the use of technology to also prevent miscalculations is found in the literature.¹⁴  One study found that the use of a dosing calculator significantly reduced medication errors.¹⁴

In addition to its potential for improving patient safety, research has shown that the use of an automated recipe calculator for infant feeding preparation improves efficiency. ^7,12  One study found that the implementation of a human milk and formula bar code scanning system which automatically calculated feeding recipes directly from the interfaced provider order decreased the daily time spent reviewing patient feeding orders by more than 50%.^7,12  Therefore, ensuring available technology has the capacity for automated infant feeding recipe calculation may be an important step in not only preventing preparation errors, but also saving staff time.  Improving efficiency can lessen the impact of workplace stressors, such as high acuity and/or inadequate staffing, which in turn reduces the risk of staff burnout.