A web prescription system for PN impacts in error reduction and processing time

Rationale: Parenteral nutritional (PN) therapy has made several advances during the last decades, most of them have been focused on building structure, equipment automation, and international regulations. Despite those advances, the prescription of PN continues in many institutions as decades ago, not using an adequate prescription system to avoid errors, regardless of the strong recommendations from ASPEN and ESPEN about this topic. Objective: Our study aims to demonstrate the streamlining of processes, the reduction of errors, and the increase in prescription safety through the implementation of a Web Prescription System (SPW). Methods: A retrospective observational and analytical study, comparing different healthcare services that solicited PN admixtures bags to a state-of-the-art Compounding Center using a custom-designed WPS and those who prescribed without it. WPS is a system allowing PN-safe prescription based on standardized recommendations by age and pathology, automatic calculation of nutrient contribution, osmolarity calculations, and alerts about instability and compatibility of the formulation. Data collected was reduced to measures of location (mean), dispersion (standard deviation), and aggregation (percentages), depending upon the type of variable. IBM-SPSS 24 program was used for statistical analysis. Results: Our compounding center produced PN for 195 institutions, 94 of them had implemented WPS (48,2%). Most of them were neonatology units (56,5%), ICU (15,8%), general wards (12,4%) homecare (11,1%), nutrition support units (2,1%), and pediatric wards (2,1%). A total of 13190 prescriptions were processed during the period of use. Through WPS, 7686 (58.3%) prescriptions were processed vs 5519 without it(41,5%). For adult patients 3288 (42,8%) vs 1902 (34,5%), pediatric 1841 (23.9%) vs 918 (16.8%), and neo-natal 2557 (33,3%) vs 2684 /48,7%) (P<0.001). The prescription processing time (in minutes) using WPS took (median; IQR 25-75%) 0.43;0,23-0,78 vs 1,13;0,62-2,41. The time reduction observed in the prescription process was 61.9% when WPS was used. Which represented a saving of 116,6 hours for every 10.000 PN prescriptions Reprocessing prescription events using WPS were 37 (0,5%) cases vs 337 (6,1%) (P<0,001), and prescriptions not using WPS required at least 2 o 3 reprocessing events. Prescription errors due to pharmaceutical mistakes in 61 cases (1.1%) and medical mistakes in 59 opportunities (1.06%) when the prescriber did not use WPS. No prescription errors were maked using WPS. Conclusion: WPS improves processing times of PN prescriptions and reduces reprocessing causes due to human error, thus helping achieve patient safety. References: Kraft MD, Tucker AM, Durfee SM, Jones T, Guenter P, Banko DE, et al. Parenteral Nutrition Prescribing and Order Review Safety Study : The Need for Pharmacist Intervention. 2020;0(0). Narula P, Hartigan D, Puntis JWL. The frequency and importance of reported errors related to parenteral nutrition in a regional paediatric centre. e-SPEN [Internet]. 2011;6(3):e131–4. Available from: https://doi.org/10.1016/j.eclnm.2011.02.005 Dumas M, Coulon S, Chouaou N, Tshipata E, Audemar J, Reitter D, et al. Parenteral nutrition Process (form medical prescription to nurse administration) without (re) Transcription. 2017. Disclosure of Interest: A. L. Martinuzzi Other: NUTRIHOME SA SPEAKER, F. Rusi Consultant for: Fresenius Kabi Consultant, A. Melita Other: FRESENIUS KABI Employee, N. Rampazzo Other: FRESENIUS KABI Employee, A. Carello Other: Fresenius Kabi Employee, R. Rodriguez Other: Fresenius Kabi Employee, J. Bernal Other: Fresenius Kabi Employee, G. Garcia Other: Fresenius Kabi Employee, M. Guidoni Other: Fresenius Kabi Employee