Medical Staff Users: Total Parenteral Nutrition (TPN) prescribing
Introduction
TPN is a specialist treatment ideally suited to electronic prescribing. This is because increasingly there are group protocols appearing for the prescribing of TPN. Interestingly prescribing of TPN does not remain exclusive to Doctors, making it more condusive to taking forward electronically in a 'modern NHS'.
Again, as with chemotherapy, this part will have to interface with a specific
part of the core pharmacy system to produce real benefits to Pharmacy. Also
because of the nature of TPN an interface to pathology systems is also an attractive idea.
What is proposed is that the prescribing of TPN is much the same as other medicines using given regimens (user defined) which
can be amended by the Prescriber or Pharmacy. The facility to prescribe a TPN order
from scratch will also be available. The core Pharmacy system will undertake compatibility
checking and component selection based on a validated/confirmed prescription.
System Requirements -Regimens
- Firstly there will be the Regimen entry screen. Each regimen will be attached to a drug file (E.g. TPN Standard 1).
A) The blank regimen screen
| Name: | (regimen name) | |
| Route: | xx | Central or Peripheral |
| Vol: | xx | ml |
| N: | xx | g |
| N: | xx | Kcal |
| CHO: | xx | Kcal |
| Fat: | xx | Kcal |
| Total: | xx | Kcal(this is SUM N, CHO, Fat Kcal) |
| Na: | xx | Mmol |
| K: | xx | Mmol |
| Ca: | xx | Mmol |
| Mg: | xx | Mmol |
| P: | xx | Mmol |
| Extra Zn: | xx | Mmol |
| Supplemental Vitamins: | (check box) | Cernevit |
| Supplemental Trace elements: | (check box) | Additrace |
| Comments | details/information entered here by Pharmacy | |
| Authorised By: | user name | Date: |
| Name: | TPN Standard 1 | |
| Route: | Central | Central or Peripheral |
| Vol: | 2500 | ml |
| N: | 12.8 | g |
| N: | 260 | Kcal |
| CHO: | 1200 | Kcal |
| Fat: | 550 | Kcal |
| Total: | 2010 | Kcal(this is SUM N, CHO, Fat Kcal) |
| Na: | 90 | Mmol |
| K: | 80 | Mmol |
| Ca: | 7.5 | Mmol |
| Mg: | 7.5 | Mmol |
| P: | 30 | Mmol |
| Extra Zn: | 0 | Mmol |
| Supplemental Vitamins: | / | Cernevit |
| Supplemental Trace elements: | / | Additrace |
| Comments | lipid mixed, additrace and vitamins added | |
| Authorised By: | WW | Date:dd/mm/yyyy |
- Access must be password controlled
- Setting a route will limit, automatically, the maximum amount of electrolytes (Sodium & potassium) per litre that may be added to a regimen.
- There must be a facility within a regimen to set maximum additions for each parameter.
- There must be a facility to copy one regimen to a new regimen.
- There must be a facility to read & or write regimens, this will be password controlled
- There must be a facility to create a hard copy of regimens
- There must be a facility to interface to the proposed core pharmacy system
Additional system requirements - TPN Prescribing
- The prescribing interface must be the same as for inpatients, outpatients' e.t.c
- Access to prescribe TPN must be restricted to those clinicians/staff authorised to prescribe such medicines.
- Upon selection of a TPN at the prescribing interface the system will display a list of available regimens
- There will be a facility to browse items within the list
- There must be a facility to prescribe non-standard regimens
- There must be a facility to review TPN history when prescribing
- There must be an option for repeat prescribing of the previous days prescription for TPN
- There must be an option to print a hard copy of TPN history
- There must be an option to confirm that TPN is to be given prior to processing by the core pharmacy system
- There must be a facility to amend parameters within a regimen within set limits
- There must be a facility for Pharmacy to amend prescriptions at the Pharmacy end as required. This will be password controlled.
- There must be a facility to enter start & stop date & times
- There must be a facility to specify pump to be used.
- There should be an option for prescription of home TPN prior to discharge.
- There should be an option to transmit the order for home TPN direct to the company contracted to supplying it.
Conclusion
This is a simplified view of the situation, ignoring details such as the proposed interface to a Pharmacy system. Another would be how would an interfaced Pharmacy system work out requirements from a prescription entered from scratch or an ammended regimen? Would users be able to precribe by product e.g. for Patient x, TPN standard regimen 1 with 30Mmol extra potassium and double the usual zinc? All valid questions and one which any system that encompassing the above functionality/interface would have to answer. The facility to provide TPN prescriptions electronically will be a very useful aspect to an electronic prescribing system, as well as being condusive to the transition from paper to 'PC'.
Copyright - Will Willson 1999
designed & written using MS notepad 8]with a little help from paint shop pro v.5