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Parenteral Nutrition

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For Administrators


For the over thirty-five years that the core parenteral nutrition (PN) computational engine has been used at Lucile Packard Children's Hospital (LPCH), not a single PN-related adverse event has been reported. In 1996, the American Society for Parenteral Enteral Nutrition (A.S.P.E.N.) published PN guidelines, many of which were adopted from the pioneering work at LPCH and the Infusion Studio design team. In 2003, Monterey Medical Solutions released Infusion Studio for Windows with several enhancements, most significant of which was paperless protocol management.

Medication errors are among the top ten causes for in-hospital death, and LPCH estimates that PN orders account for one-fourth of medication errors reported nationwide. In April of 2005, LPCH was awarded a national quality and safety award for demonstrating significant and sustained improvements in care. LPCH acknowledged that Infusion Studio played a major role in this achievement. By redesigning medication processes, of which PN is one, LPCH championed the process for improved medication practices.

Parenteral nutrition orders are unequivocally intricate, error-prone, and difficult to write because they require consideration to fluids, calories (protein, carbohydrate, fat), underlying acid-base and electrolyte disturbances, as well as other metabolic challenges of high acuity patients. In paper order processes, prescribing errors can arise from unintentional oversights in dosing, under-recognition of additional sources of fluid and electrolytes, or from computational errors. Paper orders are inherently at high risk for transcription and legibility errors. In paper ordering processes, the burden of correcting a problematic order generally falls to the pharmacist who must negotiate a correction with the ordering physician. Inevitably, some errors escape notice, putting the patient at risk for an adverse event.

Infusion Studio offers a safer and more cost-effective alternative to these risks. There is no doubt that a well written, error-free PN order minimizes staff frustration, reduces labor costs, improves patient safety, and contributes to better patient care.

Infusion Studio achieves PN process improvement by protocol management of additive ordering, completion of limit-checking before order submission, and elimination of transcription errors by using paperless order transmission. Infusion Studio is a Computerized Provider Order Entry (CPOE) system for Parenteral Nutrition that keeps prescribers compliant with hospital PN protocols established by its Nutritional Support Team and corrects potential ordering errors at point of order entry. Because the PN order complies with protocol dosing ranges and has passed limit checks before becoming available for pharmacy review, there is a limited need for order changes by the pharmacy staff, saving pharmacists substantial time expenditure on PN call-backs and error corrections.

We have performed detailed metrics on several hospitals and have demonstrated that Infusion Studio saves money. Consider the time the provider takes to manually calculate order parameters and the amount of time the pharmacist spends re-checking those computations. Consider the cost of just getting the paper order to the pharmacy. Consider the time the pharmacist spends on the telephone tracking down the provider and discussing problematic orders. Consider the time to re-enter a subsequent day's order where only a few parameters have changed. With a paper system, every PN order is an initial order. With Infusion Studio each subsequent order can be "recalled" with the most recent order entries, which generally require only minor adjustments. Infusion Studio saves time and money by eliminating, simplifying, and reducing process steps for all personnel who are involved in the process.

Infusion Studio is innovative, cutting edge, and incomparable, in a field by itself. Its implementation assures your hospital compliance with A.S.P.E.N. and American Academy of Pediatrics guidelines and starts the process of becoming one of America's safe hospitals. We look forward to adding your hospital to the list of exceptional hospitals in America.

Interested in improving your institution's parenteral nutrition formulation process? Fill out this questionnaire then let us help you review and customize your formulation process.

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