Researchers at the Johns Hopkins Children's Center have designed an online, Web-based system for ordering total parenteral nutrition (TPN) that identifies and pre-emptively eliminates potentially serious calculation errors.
The Children's Center team describes its "TPN Calculator" in the April issue of Pediatrics.
"TPN Calculator" not only reduced TPN order errors in the Hopkins Neonatal Intensive Care Unit (NICU) by nearly 90 percent, but also proved to be faster and easier to use than the standard paper-based order system, the team reports.
"TPN calculations historically have required a lengthy process involving a series of mathematical calculations to determine the correct formulations for each patient," says the study's lead author, Christoph U. Lehmann, M.D., a neonatalogist at the Children's Center. "With each step there was a potential for mistake. The calculator was developed to address the complexity and thereby reduce problems."
"Caregivers using the system report they are saving up to eight minutes per order, meaning they have more time for patient care," he adds. "This system has also had a huge impact on our pediatric 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."
Lehmann, one of the developers of the TPN Calculator, says the system's design was based on existing paper forms to provide users with a familiar format and maximum comfort level.
"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. But at the same time, we were able to provide a system we knew our users would recognize and find easy to use," he adds.
TPN provides patients with all required nutrients, including protein, fats, carbohydrates, fluid and vitamins, through a specially tailored solution given intravenously. Premature or ill infants who cannot breastfeed or take a bottle often receive TPN while in the NICU. However, because the TPN solution must be carefully formulated for each patient, hospitals nationwide have seen large numbers of medical errors associated with TPN orders.