Hello all,

1) Do you allow TPN rate changes after the TPN is initially ordered?
a. If yes, do you allow the TPN rate to be increased from the initial rate, or do you only allow rate decreases?
b. If you allow rate increases, do you outsource TPNs to a compounding pharmacy vs. compound TPNs in house to facilitate dispensing additional bags as needed when the rate is increased above the initial order and dispensed bag?
c. Is the rate change made by directly modifying the TPN order vs. on a separate order (e.g. nursing communication or other)?

2) Do you have any clinical decision support to alert to excessive rates of potassium?
a. If yes, does your clinical decision support account for potassium from all sources, e.g. TPN plus IV fluids?

Thank you in advance for sharing.

Gina

Gina Gayed, PharmD, BCPS, CPPS
Medication Safety Officer
Johns Hopkins All Children's Hospital
St. Petersburg, FL