Reduction of Pharmacist Interventions For Neonatal Total Parenteral Nutrition (TPN) Orders

1. Reduction of Pharmacist Interventions For Neonatal Total Parenteral Nutrition (TPN) Orders Pamela Nicoski PharmD, Christine H. Sajous MD, Monika Bhola MD, Julie Hrejsa RD/LD CNSD, Barbara Murphy PharmD, Marc G. Weiss MD (Sponsored by Jonathan Muraskas MD) Division of Neonatology, Loyola University Medical CenterMaywood, Illinois, USA INTRODUCTION RESULTS Physician order entry has been shown to reduce errors in medication orders secondary to both the use of decision support software and reduction of transcription errors. At Loyola University Medical Center's (LUMC) Neonatal Intensive Care Unit (NICU), we implemented a computer physician entry program as a pilot project 8 years ago for medications, laboratory orders, and total parental nutrition (TPN) orders. After implementation, we were able to reduce the number of medication orders requiring pharmacy intervention by 50%, but the incidence of interventions for Neonatal TPN orders remained at 11%. The objective of our study was to significantly reduce the number of daily pharmacist interventions thereby increasing efficiency and decreasing any potential risk of erroneous TPN administration in our NICU. After the activation of the new screens, 3 months of TPN orders were reviewed to assess effectiveness. The number of interventions for TPNs were as follows: 103/915 (Oct-Dec 2001) and 43/846 (Jul-Aug 2002). METHODS We reviewed all TPN entries from October to December 2001 and determined the most common problems encountered by TPN pharmacists. They were then classified into 6 main interventions. The computer ordering screens were changed to either clarify the choices or provide more guidelines to the staff. Our neonatal pharmacist spoke to the attendings, fellows, residents, and nurse practitioners to make them aware of these changes. Before After Guidelines for the Transition from Parenteral to Enteral Nutrition CONCLUSIONS By direct intervention (e.g., changing computer screens for clarification), we were able to reduce the number of pharmacist interventions for TPN order entry by more than 50% (p < 0.001), reducing the workload for both the staff of NICU and Pharmacy. This also reduced the potential risk of infants receiving improper TPN solution.