Abstract
The Nutrition Quality Improvement Team identified low compliance with institutional recommendations regarding total parenteral nutrition (TPN) prescribing and monitoring. Particular problems identified included excessive use of dextrose with resultant hyperglycemia and provision of the goal caloric requirements on day 1 of TPN therapy. To improve compliance, the TPN order form was revised. To determine the impact of the revisions, orders were compared for 50 patients for whom TPN had been prescribed using the original form (1996) to 50 patients using the revised form (1998). Total calories received on day 1 were significantly reduced from 25.7 ≤ 9.7 kcal/kg per day in 1996 to 21.0 ≤ 7.0 kcal/kg per day in 1998 (p = .007). Dextrose concentrations were also significantly reduced from 5.1 ≤ 2.4 g/kg per day to 3.7 ≤ 1.3 g/kg per day, respectively (p = .004). Although prescribing of calories and dextrose was reduced, the incidence of hyperglycemia was unaffected. This suggests that additional interventions are necessary to educate prescribers regarding the importance of avoiding hyperglycemia.
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