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Abstract

An increase in total parenteral nutrition (TPN) prescribing errors at Hartford Hospital provided the impetus for implementing a continuous quality improvement (CQI) program for prescribing and dispensing TPN. The CQI process identified a number of problems in the prescribing and dispensing system. A severalpronged approach that incorporated education, revision of the TPN order form, and institution of dispensing safeguards was undertaken to resolve these problems. The cornerstone of this program was the unique coupling of a drug utilization evaluation (DUE) process for TPN with an automated TPN intervention program. The computerized intervention program enabled pharmacists to prospectively document, intervene, and track TPN prescribing errors. Through the DUE feedback mechanism, individual physicians received educationally oriented feedback specific to their prescribing errors by the director of the nutrition support team (NST). Six months after implementing the CQI program, the average daily error rate decreased from 4.27% to 1.75%/d.

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References

1. Silberman, H . Consequences of malnutrition. In: Silberman H , ed. Parenteral and Enteral Nutrition, 2nd ed. Norwalk, CT: Appleton and Lange, 1989;1–17.

2. Markel KN , Marion, SA . CQI: improving the time to thrombolytic therapy for patients with acute myocardial infarction in the emergency department. J Emerg Med 1996;14:685–9.

3. Meeham TP , Radford MJ , Vaccarino LV , et al . A collaborative project in Connecticut to improve the care of patients with acute myocardial infarction. Jt Comm J Qual Impr 1996;22:751–61.

4. Eckhart J , Gilbert, P . Improved Coumadin therapy using a continuous quality improvement process. Clin Lab Manage Rev 1996;10:153–6.

5. Oetker D , Cole, C . Improving the outcome of emergency department patients with a chief complaint of chest pain. J Nurs Care Qual 1996;10:58–74.

6. Krall SP , Reese CL IV , Donahue L. Effect of continuous quality improvement methods on reducing triage to thrombolytic interval for acute myocardial infarction. Acad Emerg Med 1995;2:603–9.

7. Schwartz, DB . Enhanced enteral and parenteral nutrition practice and outcomes in an intensive care unit with a hospital-wide performance improvement process. J Am Diet Assoc 1996;96:484–9.

8. Hester DD , Coghlin TM , Hsieh, NL . Evaluation of the appropriate use of parenteral nutrition in an acute care setting. J Am Diet Assoc 1996;96:602–3.

9. Dougherty D , Bankhead R , Kushner R , et al . Nutrition care given new importance in JCAHO standards. Nutr Clin Pract 1995;10:26–31.

A CQI Program for Prescribing and Dispensing Total Parenteral Nutrition

Abstract

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References