Mitchell K A, Jones E A, Meguid M M, Curtas S
Department of Pharmacy, University Hospital, SUNY Health Science Center, Syracuse 13210.
Nutrition. 1990 Nov-Dec;6(6):457-60.
The Nutrition Support Team developed a standardized parenteral nutrition (PN) order form for the newly introduced total nutritional admixture (TNA) system. The new order form (TNA-Form) is oriented toward the physician, providing prescription guidelines and standing orders for the initiation and discontinuation of PN. The form replaced an older one (TPN-Form) originally designed for pharmacy use. Over two 4-month periods, the usefulness of the new TNA-Form was compared with that of the old TPN-Form, with reviews of the completeness and safety of all PN prescriptions. When prescription errors, errors of dosage, or errors of omission occurred, the pharmacist queried the physician. The number and the nature of the prescription errors per PN order were recorded daily for each patient. With the old TPN-Form, there were 634 prescription errors in 682 patients (93% total error rate). This rate decreased to 116 prescription errors in 1017 patients (11% total error rate) with the new TNA-Form. There were fewer errors in all categories concerning glucose and lipid concentrations, trace elements and vitamins, the use of heparin, infusion rate, and electrolyte concentrations. It was concluded that the new TNA-Form led to a substantial decrease in overall PN prescription errors, particularly errors of omission, resulting in safer, more efficacious, and more uniform provision of PN. The new TNA-Form provided the secondary benefit of an educational tool for housestaff. Because of its broad-based benefits, it was subsequently adopted by two other hospitals in the community.
营养支持团队为新引入的全营养混合液（TNA）系统制定了一份标准化的肠外营养（PN）医嘱单。新的医嘱单（TNA-Form）是面向医生的，提供了PN起始和停用的处方指南及长期医嘱。该表单取代了原本为药房使用而设计的旧表单（TPN-Form）。在两个为期4个月的时间段内，对新的TNA-Form与旧的TPN-Form的实用性进行了比较，并对所有PN处方的完整性和安全性进行了审查。当出现处方错误、剂量错误或遗漏错误时，药剂师会向医生询问。每天记录每位患者每份PN医嘱的处方错误数量和性质。使用旧的TPN-Form时，682例患者中有634例处方错误（总错误率93%）。使用新的TNA-Form时，该比率降至1017例患者中的116例处方错误（总错误率11%）。在葡萄糖和脂质浓度、微量元素和维生素、肝素的使用、输注速率以及电解质浓度等所有类别中，错误都减少了。得出的结论是，新的TNA-Form使PN处方的总体错误大幅减少，尤其是遗漏错误，从而实现了更安全、更有效和更统一的PN供应。新的TNA-Form还为住院医生提供了教育工具这一附带益处。由于其广泛的益处，随后被社区中的另外两家医院采用。
