TPN Calculator: TPN Calculator Dr Jaimin Patel
PGY-1 Pediatrics
How many total TPN Orders.: How many total TPN Orders. 15-30 from NICU
2-5 from Intermediate Nursery.
Background.: Background. Errors
Osmolarity
Calculation
Missing information
Glucose Rate
Accuracy
Person to person variation
Time consumed
What will it look like?: What will it look like?
How will it look like?: How will it look like?
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Software: Software Front End : Visual Basic Express
Back End : Database – SQL Server Express Edition.
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What I will need?: What I will need? Consensus on Electrolytes adjustment in the TPN based on the S. Electrolyte concentrations
Haemolysed samples- K+ Values
Dextrose concentrations.
Functional Design (Fluids): Functional Design (Fluids) Fluid Rates
For andlt;1000 gms
For 1001 to 1500 gms
For andgt;1500 gms
Rate of increase
15 ?
20 ?
Maximum Fluid Rate
150
190
Functional Design (Dextrose): Functional Design (Dextrose) Minimum 2.5
Max
Peripheral 12.5
Central 25 Max
Mean S. Glucose level?
Criteria for increasing Dextrose conc.
Criteria for decreasing Dextrose conc.
Functional Design (lipids): Functional Design (lipids) If baby is andlt;1000 gms
TPN day 1 Start Lipids
0.5 gm/kg/day
TPN day andgt;= 2 and TPN Lipids andlt;=2.5 gm/kg/day.
Previous day TPN Lipids + 0.5 gm/kg/day
If baby is andgt;=1000 gms
TPN day 1 Start Lipids
1 gm/kg/day
TPN day andgt;= 2 and TPN Lipids andlt;=2 gm/kg/day.
Previous day TPN Lipids + 1 gm/kg/day
Triglycerides if andgt;200 mg/dl IL rate must be decreased.
Consider Limiting lipids for Hyperbilirubinemia, Sepsis or PPHN.
If baby is more than Half feeds, stop LIPIDs in TPN
Functional Design (Amino Acids): Functional Design (Amino Acids) If baby is andlt;1000 gms
TPN day 1 Start Trophamine
1.5 gm/kg/day
TPN day andgt;= 2 and TPN Trophamine andlt;=2.5 gm/kg/day. (max 3.5)
Previous day TPN Trophamine + 1 gm/kg/day
If baby is andgt;=1000 gms
TPN day 1 Start Trophamine
2 gm/kg/day
TPN day andgt;= 2 and TPN Lipids andlt;=2.5 gm/kg/day.
Previous day TPN Trophamine + 1 gm/kg/day
If BUN 30 to ___
Decrease Trophamine by ____gm/kg/day
If BUN andgt;________
Stop Trophamine.
If Cholestasis –S. Bili andgt; __________
Trophamine max 3 gm/kg/day.
Electrolytes: Electrolytes Ranges and mEq/100 ml of TPN
Sodium 2-5 mEq/kg/day
Potassium 2-4 mEq/kg/day
Calcium Gluconate 1-4 mEq/kg/day
Cysteine
If Blood Gases not available.
IF Renal compromise (do not add)
Creatinine? Cut off?
What I will Need?: What I will Need? IRB approval.
ITR support to plug in the last SMA-7 Values and to develop software.
Support from the pharmacist to collect data.
Support from attending for the functional Design.
Study Design: Study Design Trailing: 50 orders on Computer.
?Only 2nd year resident
TPN orders
Same resident for
Same patient on
two different days.
Day1 Half Manual/Half On Computer.
Day2 Will Switch the groups.
Time spent on the variable collection for the patients will not be counted.
He/She should not be 'Post call'.
Timing by the residents Himself/Herself.
Definition : Medical Error: Definition : Medical Error The National Coordinating Council for Medication Error and Prevention (NCCMERP),
'A medication error is any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the health care professional, patient, or consumer.
Such events may be related to
professional practice,
health care products,
procedures, and
systems, including
prescribing;
order communication;
product labeling,
packaging, and
nomenclature;
compounding;
dispensing;
distribution;
administration;
education;
monitoring; and
use
Error Detection Method: Error Detection Method 1st order faxed between 5 AM- 12 noon for the patient will be evaluated.
It will be checked for
Illegible handwriting
Missing information
Wrong Calculation
Osmolarity
Medication errors/fluid rate errors
Amphotericin B- change in fluid rate
Heparin
Data collection : Errors: Data collection : Errors
Data Collection: Data Collection
Questions: Questions
What other things can be measured and compared statistically?
Slide22: http://www.tpncalculator.com