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Neonatal TPN prescription

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Context

We use standard formulae for our neonatal parenteral nutrition. There were errors in manual calculations of infusions rates and fluid requirements. Risk of fluid overload and error calculation of additional electrolytes to be added to 500ml volume side-arm bags was necessary to give the desired electrolyte concentrations. Also it was time consuming to calculate nutrition intake per kg body weight.

 

Aims

To improve the safety of prescribing: automate calculations, reduce risk of fluid overload, calculate any additional sodium, potassium, calcium needed in side-arm and set limits for maximum concentration of these (per 500ml), estimate daily intake of nutrients from the parenteral nutrition.

Description

The spread sheet does not allow the total daily intake figure to be exceeded. It will take into account the volume of enteral feeds and fluid from other infusion and flushes if entered. If the total daily intake minus the infusions, flushes , and enteral nutrition exceeds the prescribed intake for parenteral nutrition, the intake of PN is cut back. The PN formulations are choosen from drop down lists.

Implementation

The tool is used daily on the ward to prescribe PN. It can be used to check calculation of electrolytes to be added to 500ml and infusion rates when prescribed as mml/kg/day.

Suggestions for further implementation

The tool can be adapted for other formulae. We are working on one for our paediatric PN formulae. The tool can be developed to include the nutritional content from the enteral route as well as the parenteral route.

Challenges and learning

Develop its iterations. Pilot and check calculations manually – feedback on problems and issues is critical.

Quality assurance/MHRA registration

Approved by local Trust.