Automation helps hospital greatly reduce parenteral nutrition errors

An automated electronic ordering and compounding system, developed in-house a few years ago, has helped Salt Lake City, Utah-based Primary Children’s Hospital nearly eliminate parenteral nutrition (PN) errors.

Nine years ago, Mark MacKay, BS Pharm, clinical manager for the 350-bed hospital, solicited input from a multidisciplinary team of pharmacists, physicians, nurse practitioners, nurses, dietitians, and others.

The team identified PN practices that led to errors and decided to implement a completely electronic system for ordering and reviewing PNs.

The software, developed by the hospital’s IT department, allows the licensed practitioner to order individual components such as macronutrient glucose, protein, and fats along with micronutrients and trace minerals. Then, the program doses all the calculations based on the patient’s weight, while checking for any errors in ordering and incompatibilities. When an error is found a pop up box identifies the error and provides solutions to prevent the errors.

MacKay and the team opted for an in-house software system, because there were no vendors available at the time. “As the program advanced and our research continued to expand in parenteral compatibility, the information was incorporated into the computer program,” MacKay told Drug Topics.

“An example was adding calcium and phosphorus solubility curves as an automatic checking process. The program recognizes formula adjustment, compatibility, and dosage problems, providing the user with real-time solutions…thus eliminating any paper trails from ordering to compounding,” MacKay said.

MacKay and the team tracked the impact of the program from 2007 through 2014. Out of 84,503 PN prescriptions, 230 errors occurred. Ninety-five percent of all errors occurred during administration, and there were no transcription errors, according to ASHP Intersections.

While 9.1% of errors may have contributed to patient harm, the events fell in the “temporary harm” category. “By addressing those components, we reduced the error rate to nearly zero, leaving drug administration as the only remaining task where errors may occur,” MacKay said.

In addition to a significant reduction in errors, the average savings were $137,629 per year or $963,403 over seven years, thanks to decreased waste elimination and direct formulary control, according to ASHP Intersections.

While the electronic ordering system, as well as the multidisciplinary team played a role in the success of the program, “the impact of continuation came when the hospital allowed for the development of a nutrition support team to oversee the program and maintain the daily continuation and compliance of the program,” MacKay said.