Proposed Topic (Most preferred): :
Clinical Safety and Quality Service II (Projects aiming to enhance clinical safety and outcomes, clinical governance / risk management)
Proposed Topic (Second preferred): :
Clinical Safety and Quality Service I (Projects aiming to improve efficiency and effectiveness of care delivery to meet international standards)
Authors (including presenting author) :
Chan CC(1), Li WT(1), Wong SY(1), Khan I(2), Yeung TT(2)
Affiliation :
(1) Department of Pharmacy, Queen Mary Hospital, (2) Information Technology Department, Hong Kong West Cluster
Introduction :
Parenteral Nutrition, sometimes known as Total Parenteral Nutrition (TPN), is a mixture containing up to 20 or more ingredients that are infused into patients' vein to provide necessary nutrition support. Due to its complex nature, it is often prone to medication errors. And errors regarding concentrated electrolytes could lead to serious complications. Currently in Queen Mary Hospital (QMH), ready-to-use TPN are prescribed on a paper form which includes a reference table of maximum volumes of various additives for every formula. However, prescribers, especially paediatricians and dietitians, often require tedious and complicated manual calculation of the nutrition value of the TPN regimen in order to suit individual's needs. Also, due to limited space, the form lacks information on the dosage recommendations, contents of each formula and the necessary monitoring parameters, making the prescribing process even more difficult. Besides, since osmolarity calculation is time-consuming and complicated, the value is often assumed to be suitable for peripheral use when peripheral formula is chosen despite addition of other additives.
Objectives :
The aim of this project is to develop an online prescribing guide for ready-to-use TPN for doctors, dietitians, pharmacists and nurses to facilitate the efficacy and safety of TPN regimens.
Methodology :
From 1 Mar 2023, pharmacists of QMH have collaborated with information technology department of Hong Kong West Cluster to develop a multi-functional page for prescribing ready-to-use TPN. The webpage involves several tab pages, which most notably includes calculator which display the formula content, maximum volume of additives allowed to be added based on compatibility data, licensed dosage of various products, and calculation of nutrition values and osmolarity. In addition, there are tab pages showing the comparison tables, clinical references and monitoring parameters. Lastly, a report of the regimen can be generated serving as a documentation and reference for future prescribing.
Result & Outcome :
The TPN Prescribing Guide will be launched in HKWC in 2024. It is anticipated to improve both patient outcomes and medication safety by assisting frontline prescribers to choose the best suitable parenteral nutrition regimen for patients and pharmacists to verify the respective orders under a guided approach of IT systems.
