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Standardized TPN order form reduces staff time and potential for error.
K A Mitchell1, E A Jones, M M Meguid
1Department of Pharmacy, University Hospital, SUNY Health Science Center, Syracuse 13210.
Nutrition (Burbank, Los Angeles County, Calif.)
|November 1, 1990
Summary
A new standardized parenteral nutrition (PN) order form significantly reduced prescription errors. The TNA-Form improved patient safety and PN provision, serving as an educational tool for physicians.
Area of Science:
- Clinical Pharmacy
- Nutrition Support
- Patient Safety
Background:
- Parenteral nutrition (PN) is complex, requiring precise prescription to ensure efficacy and safety.
- Existing order forms may not adequately address the complexities of modern PN systems like total nutritional admixture (TNA).
- Standardization of PN ordering processes is crucial for minimizing errors.
Purpose of the Study:
- To evaluate the impact of a newly developed, physician-oriented TNA order form on the completeness and safety of PN prescriptions.
- To compare the error rates associated with the new TNA-Form versus the older, pharmacy-oriented TPN-Form.
- To assess the overall effect of the TNA-Form on the quality of PN delivery.
Main Methods:
- A standardized TNA order form (TNA-Form) was implemented, replacing an older TPN-Form.
- Two 4-month periods were compared to assess the usefulness of the new form.
- PN prescriptions were reviewed for completeness and safety, with errors meticulously recorded.
- Pharmacists queried physicians regarding any identified prescription errors, dosage errors, or omissions.
Main Results:
- The total error rate decreased dramatically from 93% (634 errors in 682 patients) with the TPN-Form to 11% (116 errors in 1017 patients) with the TNA-Form.
- Significant reductions in errors were observed across all categories, including glucose, lipids, electrolytes, trace elements, vitamins, and heparin use.
- Errors of omission, in particular, were substantially reduced, leading to more consistent PN administration.
Conclusions:
- The new physician-oriented TNA-Form significantly reduces parenteral nutrition prescription errors, enhancing patient safety and treatment efficacy.
- The TNA-Form promotes more uniform and safer PN provision and serves as an effective educational tool for healthcare professionals.
- The success of the TNA-Form led to its adoption by other healthcare facilities, highlighting its broad-based benefits.