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Total parenteral nutrition: a concurrent drug utilization review
The Canadian Journal of Hospital Pharmacy
|January 10, 1988
Summary
This study evaluated the effectiveness of Total Parenteral Nutrition (TPN) protocols at a teaching hospital, finding significant issues with caloric delivery and adherence to therapy duration guidelines.
Area of Science:
- Clinical Pharmacy
- Nutritional Support
- Healthcare Quality Improvement
Background:
- University Hospital utilizes three standard Total Parenteral Nutrition (TPN) base formulae for approximately 150 patients annually.
- Physician orders for TPN are managed through preprinted forms, necessitating a review of protocol adherence.
Purpose of the Study:
- To conduct a Drug Utilization Review (DUR) assessing adherence to the current TPN protocol in 30 patients.
- To evaluate criteria including enteral feeding exclusion, TPN indications, therapy duration, laboratory monitoring, and caloric delivery accuracy.
Main Methods:
- A retrospective review of 30 TPN patient cases was performed.
- Evaluation focused on protocol adherence, comparing physician/dietician caloric estimations with ordered calories.
- Data on pharmacist interventions and TPN bag wastage were collected.
Main Results:
- Inadequate information prevented assessment of enteral feeding exclusion and TPN indications.
- 23% of patients did not meet the minimum five-day TPN therapy duration.
- Only 45% of patients achieved their caloric goals, highlighting disparities in TPN management.
- 77% of required laboratory monitoring tests were completed.
Conclusions:
- Significant discrepancies exist in caloric calculation and delivery within the TPN protocol.
- Recommendations were proposed to enhance TPN protocol and patient therapy management.
- Further improvements in TPN administration and monitoring are warranted.