Authors (including presenting author) :
Chan VPY(1), Hung GKZ(2), Ku SW(2), Ng HM(1), Chee YY(2), Man E(2), Cheung TF(2), Li WY(2), Wong MSR(2)
Affiliation :
(1) Department of Pharmacy, Hong Kong Children’s Hospital (2) Department of Paediatrics, Hong Kong Children’s Hospital
Introduction :
Standardization plays an important role in enhancing patient safety, improving efficiency, reducing cost and improving patient outcomes. This is especially important in the pediatric setting as they are vulnerable to serious and sometimes fatal adverse drug events. An electronic parenteral nutrition (PN) ordering program has been developed in the Clinical Information System (CIS) to standardize nutritional calculations, dose range and overdose alert and also provides solution to reduce transcription errors. Standard continuous infusion drug database has also been developed in CIS to reduce the variability of available concentrations, diluent, usual and maximum drug range for the same drug during transitions in PNICU and Cardiology department in Hong Kong Children’s Hospital (HKCH) to reduce the likelihood of errors.
Objectives :
To design and implement an electronic PN prescribing program and standard continuous infusion database, aiming to: (1) Improve safety and minimize errors in prescribing PN and IV medications (2) Standardize the prescription of continuous infusion in HKCH.
Methodology :
In 2019, the Clinical Team and Pharmacists collaborated to create an electronic parenteral nutrition ordering system and to standardize the continuous infusion drug database for intrahospital use in HKCH.
(a) PN system
By entering the nutrient dosing in the TPN form, nutritional calculations would be generated. “Alert prompts” are in place to alert the physician and pharmacist when the nutrient dosing is out of the desired range. Full history of PN orders are available to aid prescribing. PN orders are processed electronically by pharmacy. This ordering system serves as an important communication channel between the prescribing physician and the pharmacy team.
(b) Standard database
The dilution concentration, diluent, maximum concentration and usual dose range have been standardized for 26 continuous infusion drugs in PNICU and Cardiology department.
Result & Outcome :
The electronic PN ordering system and standard concentration database was launched in HKCH in July 2019. It is novel for being paperless in the entire process. The standard concentration database is in use in the PNICU and OT and limits calculation errors due to variability in body weight in the pediatric population.
