A CQI Program for Prescribing and Dispensing Total Parenteral Nutrition

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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