Category: Professional Posters
Purpose: Parenteral nutrition provides critical intravenous (IV) nutrition for patients who cannot tolerate enteral nutrition, but prescribing and compounding complexities make the process vulnerable to medication errors. Standardizing electronic parenteral nutrition ordering has been shown to decrease ordering errors, resulting in a safer, more uniform provision of parenteral nutrition. A large health system historically utilized multiple parenteral nutrition order sets, a variety of parenteral nutrition products, and some outsourcing services for compounding parenteral nutrition. A change in manufacturer-provided premix product availability prompted a time-critical standardization of parenteral nutrition products and ordering processes at the health system for adult patients.
Methods: Standardization of parenteral nutrition orders and products had been attempted in the past and sensitized the organization to be successful. An interdisciplinary workgroup of pharmacists and dietitians was developed and met for four months. Discussions centered on evaluation of products, comparison of preparations and order sets used between hospitals in the health system, evaluation of ordering elements, and education development. Examples of recommendations included creating an order cut off time, standard administration hang time, standard lipid volume, and standard multivitamins. The recommendations developed from this workgroup were presented to the relevant formulary and order set committees for approval. Once the standardized recommendations were implemented into the electronic medication record, a nursing survey was planned and executed to evaluate the success of the initiative. The workgroup met for an additional post-go-live review over three months to address any additional issues. The project was then completed after seven months of work effort.
Results: Parenteral nutrition products were standardized from over 20 product preparations to three preparations and from eleven order sets to two order sets. Items standardized included lipid volume and infusion time, minimum hours for cycling, hang time, order cut off time, maximum administration rate, trace elements, multi-dose vitamin, and recommended/optional laboratory orders. Minor modifications were addressed to improve wording in the order sets and address nursing survey feedback.
Conclusion: Creation of two order sets has introduced efficiencies in maintaining parenteral nutrition ordering in the electronic medication record. The focus on process improvement and engagement from stakeholders was key to successful implementation and standardization of parenteral nutrition ordering and parenteral nutrition products for adult patients at a large health system.