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Universal Health Services

TPN Advisor helps improve patient safety, eliminates manual calculations

Clinicians at Universal Health Services have developed an innovative tool to ensure patients who need an alternate feeding method get the right nutrients. Providers and pharmacists have a tool to help calculate total parenteral nutrition (TPN), the substance utilized for intravenous nutritional supplementation. TPN Advisor, built by Crossings Healthcare Solutions, a subsidiary of UHS, integrates with the Cerner Millennium® electronic health record and eliminates manual paperwork while helping improve patient safety.

“About four years ago, we developed and started using TPN Advisor,” said Marreddy Yeruva, MD, associate chief medical information officer, UHS. “We’ve been thrilled to embed our tool within Cerner, optimizing the system and ensuring our patients at UHS receive top-quality care.”

“The whole process is a lot easier than it used to be,” said Robert Abda, MIS, RN, BSN, nurse clinical informaticist, UHS. “Everything is in the workflow. It’s integrated and easy to access. More importantly, there is peace of mind that I’m entering the information accurately, efficiently and quickly.”

From January 2019 through February 2020, providers utilized the advisor more than 21,500 times, helping ensure patients received the correct dosage amounts.

All safety features follow the American Society of Parenteral and Enteral (ASPEN) guideline recommendations and include clinical decision support alerts that warn providers and pharmacists during the TPN ordering process if the TPN mixture exceeds safety range guidelines. If it is slightly out of guideline ranges, a soft stop alert informs the ordering provider, who can override the warning if necessary. If the mixture largely exceeds the recommended range, a hard stop alert also pops up, and pharmacists cannot override the alert.

Once the pharmacist verifies the TPN mixture in MedManager, a pharmacy tool that processes and dispenses medications, the order is electronically transmitted to the TPN compounder, which contains additional decision support, as a second line, to ensure all preventable errors are caught.

In February 2020, UHS began utilizing the alerts, which fired 60 times, alerting providers of potential incorrect dosage amounts.

“Those alerts are there to make sure we have the right dosage every time for our patients,” said Yeruva. “We want to make sure that there aren’t any errors in the TPN mixture.”

UHS currently utilizes TPN Advisor within Cerner Millennium at all 27 of its acute care facilities, and the advisor is in use outside of UHS at another 17 facilities.

“We’re proud of the success we’ve seen not only at our own facilities but also at organizations outside of UHS; a clear benefit for providers, pharmacists and especially our patients,” said Tim Killian, pharmacy manager, UHS.

“For more information, contact Susan Armbruster at Crossings Healthcare Solutions.”

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Client outcomes were achieved in respective settings and are not representative of benefits realized by all clients due to many variables, including solution scope, client capabilities and business and implementation models.