Online calculator for TPN reduces ordering errors and saves time
An online system for ordering neonatal total parenteral nutrition (TPN), which took just three weeks to develop, has reduced errors by 89 per cent at a hospital in the US.
The system, developed at the Johns Hopkins Hospital, Baltimore, Maryland, also
proved quicker and easier to use than the paper order forms it replaced.
Although it is based on the paper form, the online version computes all necessary
fluid and component calculations. It also contains nutritional guidelines, an
osmolality calculator and 62 rule-based alerts and reminders. For example, the
user is prompted if a child is outside the normal weight range for a given age,
if certain elements or patient details have been omitted, with dose range alerts
included.
Reporting on the “overwhelming success” of the system, researchers
from the hospital recorded a baseline of 60 errors using the paper system (10.8
per 100 TPN orders) from October to November 2000. After replacement by the online
TPN calculator, the number of errors fell to 20 (4.2 errors per 100 orders) from
November to December 2000. Two years later, the error rate had fallen more dramatically,
with just eight errors (1.2 errors per 100 orders) detected from August to October
2002 (Pediatrics 2004;113:748).
Paediatrician Christoph Lehmann, one of the developers of the program, said that
caregivers using the system were also reporting saving up to eight minutes per
order, meaning they had more time for patient care.
He added, “This system has also had a huge impact on our paediatric pharmacists,
who previously had to recalculate each individual TPN order that they received.
Now, rather than recalculating everything by hand, they can simply review each
online order.”
He added: “We addressed only what was thought to be the ‘broken link’ in
the TPN order process, namely calculation errors and knowledge problems, in order
to preserve the majority of the existing ordering process.” |
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