Quality improvement for parenteral nutrition in hospital: Applying a gap analysis to an electronic health record to review parenteral nutrition processing.

IF 2.1 4区 医学 Q3 NUTRITION & DIETETICS Nutrition in Clinical Practice Pub Date : 2024-12-18 DOI:10.1002/ncp.11254
Andrea Kulyk, Jolayne Dahmer, Leah Gramlich
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Abstract

Background: In light of the complex and high-risk nature of parenteral nutrition (PN), reviewing PN processing steps is essential to minimize patient harm. The main steps include ordering, verification, compounding, and administration. Electronic health records (EHRs) have become increasingly utilized and can play a critical role in enhancing the safety of PN processin. Epic EHR is used throughout all PN processing steps within our health system. There is limited literature on health system quality improvement initiatives in PN processing.

Methods: We reviewed the steps of PN processing in our health region and applied a gap analysis to assess Epic's functionality in PN processing. This gap analysis aimed to identify opportunities to enhance PN safety.

Results: Epic applies 32 of 40 functions that enhance PN safety. We selected three functions to prioritize adding into future EHR iterations; these include (1) bidirectional automatic interfacing between the automated compounding device and EHR reflecting real-time updates on product availability/shortages, (2) automatically transmitting a pharmacist-modified PN order back to the prescriber for approval, and (3) adding additional clinical decision support tools, one of which is incorporating a 3-in-1 qualification calculator and the second is requiring prescriber justification for using compounded formulations over multichamber bags. Additional opportunities for improving safety in PN processing were identified and added to the gap analysis.

Conclusion: Using a gap analysis is a simple process to review a health system's EHR to identify opportunities to enhance patient care.

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医院肠外营养质量改进:应用差距分析对电子健康记录进行肠外营养处理审查。
背景:鉴于肠外营养(PN)的复杂性和高风险性质,回顾肠外营养的处理步骤是必要的,以尽量减少患者的伤害。主要步骤包括订购、验证、组合和管理。电子病历(EHRs)的应用越来越广泛,在提高PN过程的安全性方面发挥着至关重要的作用。Epic EHR在我们的卫生系统中用于所有PN处理步骤。关于PN处理中卫生系统质量改进举措的文献有限。方法:我们回顾了我们健康地区的PN处理步骤,并应用差距分析来评估Epic在PN处理中的功能。该差距分析旨在确定提高PN安全性的机会。结果:Epic应用了40种功能中的32种增强PN安全性。我们选择了三个功能来优先添加到未来的EHR迭代中;这些包括(1)自动配药设备和EHR之间的双向自动接口,反映产品可用性/短缺的实时更新,(2)自动将药剂师修改的PN订单传回处方者批准,以及(3)增加额外的临床决策支持工具,其中一个是合并三合一资格计算器,第二个是要求处方者证明使用复合配方而不是多室袋。确定了提高PN处理安全性的其他机会,并将其添加到差距分析中。结论:使用差距分析是一个简单的过程,可以审查卫生系统的电子病历,以确定加强患者护理的机会。
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来源期刊
CiteScore
6.00
自引率
9.70%
发文量
128
审稿时长
3 months
期刊介绍: NCP is a peer-reviewed, interdisciplinary publication that publishes articles about the scientific basis and clinical application of nutrition and nutrition support. NCP contains comprehensive reviews, clinical research, case observations, and other types of papers written by experts in the field of nutrition and health care practitioners involved in the delivery of specialized nutrition support. This journal is a member of the Committee on Publication Ethics (COPE).
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