| Abstract | Background: Computerized decision-support applications can simplify the
process of ordering drugs and solutions in the Neonatal Intensive Care
Unit (NICU) and reduce the incidence of calculation errors. The World
Wide Web (WWW) has made it possible to rapidly build and deploy such
applications in a platform-independent manner.
Methods: Parallel versions of several WWW-based applications for the
NICU were developed in both client-side JavaScript and server-side
Microsoft Active Server Pages (ASP) to test performance and portability
on a variety of WWW browsers. Certain of the applications were
previously implemented in Microsoft Basic, VAX RDB, Apple HyperCard, or
Symantec ThinkC. Information is collected from the clinician via Hyper
Text Markup Language (HTML) "forms" displayed in a WWW browser.
Calculations are carried out on the client (JavaScript versions) or on
the server (ASP versions), using information stored on the server. The
results are delivered to the user via the browser.
Graphs and charts are created dynamically and embedded in WWW pages
using ServerObjects' ASPChart, an ActiveX module that can be called from
an ASP application to generate JPEG images.
Results: The four WWW-based patient-care applications listed below are
now in routine use in the CSMC NICU.
(1) Quick IV: The physician supplies the patient's weight and the
desired amount of fluids, dextrose, sodium, potassium, calcium, and
heparin per unit weight per day. The application calculates the exact
amounts of fluids, dextrose, electrolytes, and heparin to mix in the IV
solution, along with the delivery rate.
(2) Quick Drip: The physician selects a constant infusion medication
from a list and supplies the patient's weight, the desired volume per
hour, and the desired dose-per-weight-per-unit time. The application
checks the dosage against built-in limits and calculates the amount of
drug to be mixed in a standard volume.
(3) Code Sheet: The physician supplies the patient's name, weight, and
birth-date. The application calculates patient-specific dosages for
drugs used during a neonatal resuscitation, and generates a "Code Sheet"
that can be printed and posted at the bedside for ready reference during
an emergency.
(4) Growth Chart: The application generates three different charts of
weight and head circumference for the period from 24 weeks gestation to
term-plus-three-months, based on curves published in the pediatric
literature, and plots the patient's weights on the curves.
Conclusion: The explosion of the Internet and the WWW, and the
proliferation of low-cost, powerful, easy-to-use devel-opment tools for
WWW servers and applications, have made it easy to build user-friendly,
graphically-enabled, platform-independent decision support appli-cations
for physicians and nurses working in the NICU. These applications can be
accessed from clinical workstations throughout the patient care areas,
as well as the desktop computers in the physician and nurse offices. |