Procedure documentationCreating Orders for Nutritional Solutions (TPN)

 

You use this medication order to order nutritional solutions. The order contains special screen areas for base ingredients and additives.

A nutritional solution is similar to an infusion, but contains additives instead of one active ingredient. The nutritional solution (TPN) has only one flow rate.

Note Note

You can also create an order without an end date. The system creates an order without an end date if you do not enter an order duration or an end date for the order.

You should note that the system cannot calculate the overall quantity of an order without an end date.

When generating events the system uses the event generation horizon which is entered in the master data of the corresponding drug (Inpatient tab page). If the event generation horizon is not determined in the drug master, the system uses the value of system parameter N1MEEVTH or, if the system parameter is not maintained, a standard duration of 5 days.

See System Parameters for Medication

End of the note.

The Activate Suspended function is provided in the medication order dialog for the entry of initially suspended medication orders. This function activates a new order, as yet unsaved, while automatically setting the suspension start date to the order start and adjusting the change history accordingly.

Prerequisites

You select a nutritional solution in the drug search or in the order.

Note Note

In Customizing, you can determine user-specific presettings for order management, to control and preset the data in the order. The system takes into account the presettings assigned to the user when creating an order.

See Maintaining User-Specific Presettings

See Order Management Tab Page

End of the note.

Procedure

  1. Select a patient in a view in the clinical work station or in the patient organizer and choose Create Order (Create Order).

    Alternatively you can create an order using a corresponding task in the documentation work station.

    You can also create a new order in the order dialog. To do this, choose Create Order.

    Note Note

    As the order type results from the order process, the system does not support the transfer of the order type from the order template.

    End of the note.

    Depending on the user parameter N1ME_NO_DRUG_SEL you will access the drug search or the Create Order screen.

    In the drug search you can also search for order templates which you can use as a basis for the order you wish to create.

    See Finding Drugs Using Order Templates

  2. Select the nutritional solutions to be ordered in the drug search or in the input help of the Drug ID field on the Create Order screen.

  3. Enter the required data in the compressed view of the order.

    In the compressed view the system displays each order in a separate row. Depending on the user parameter N1ME_ORDGRI_OPENROW the system highlights the opened (selected) order (row) in the Compressed View.

    The system presets the following order data:

    • Depending on the user parameter N1ME_DEFOTYP the system presets the order type.

    • The system presets the standard dose, the administration route, etc. from the drug master data.

    If you create an order for an intermittent nutritional solution, determine the individual dose for each administration time and have entered a quantity in cycle definition, the system will combine this information. The quantity entered in the cycle is used as a multiplier. In this way you can define administrations which are irregular as far as the quantity is concerned.

    Furthermore the system will also check the combination of individual dose and cycle against the daily dose. Note that, for this, the system will use the 24 hours before the administration time which results from the cycle as the day. The system displays a warning if necessary. The system will also display this warning if the daily dose is exceeded in the following ways:

    • by manually created new events in the order

    • by changing the dose of the events with the Administration purpose

    • by changing the administration time

    The system will take into account the components of an administered drug and any other valid orders which may simultaneously exist for the patient and which contain the same drug. The system will not take into account drugs with the same agents when checking the maximum daily dose.

    Note Note

    Note that the flow rate duration of an intermittent nutritional solution should not be longer than the smallest interval in hours defined in the cycle. Otherwise this would result in events which must be begun although the application of the previous event is not yet completed. A cumulation of flow rates would result due to the hanging of an addition bag/bottle.

    End of the note.

    If you use “Dose” as the unit for the duration of the order for nutritional solutions, the system will use the individual dose entered in the order as the basis for event generation.

  4. Choose Detail (Detail) in the row of the order in the compressed view, to open this order in the Expanded View.

  5. Choose Change Drug, to have the system propose alternative drugs for the selected order.

    See Changing Drugs

    Note Note

    Note that if you change the order description by selecting another drug in the Propose Alternatives and Propose Issue Quantity functions the system will overwrite using the drug description of the alternative.

    In such cases you should therefore use the Comment field in the order which is not overwritten by the system when alternative drugs are selected.

    End of the note.

  6. Enter the data necessary for ordering nutritional solutions on the following tab pages of the expanded view:

    • Order Tab Page

      When you create an anamnestic order, the system sets the Anamnesis value in the Pat. Own Medic. field for the patient's own medication. The system cannot generate events for this anamnestic order. However, this medication may be relevant for clinical interaction checks, which are only possible if an order exists.

      The system presets the organizational units on this tab page using the case.

      Furthermore you can also create a check condition for the order and indicate that the prerequisite entered there must be checked before a drug can be administered.

      The Check Condition is set under the following circumstances and is no longer ready for input:

      • the Check Condition Indicator is set in the drug master

      • the PRN Medication indicator is set in the compressed view

      • the Conditional Continuous radio button is set

      • minimum and maximum rates have been defined

    • Sliding Dose tab page

      See Sliding Dose

    • Event tab page

      You can define a different fill source for the first event, e.g. the drug stockroom of the care unit or outpatient clinic.

      Note Note

      Choose Replace Drug for Event (Replace Drug for Event) to call the manual substitution for medication events.

      End of the note.

  7. Enter the special data for the ingredients of nutritional solutions on the Base Ingredients tab page.

    The system calculates the solution from the total volume of the nutritional solution minus the total volume of the ingredients and additives.

    Caution Caution

    If an ingredient cannot be entered or converted into in a volume unit, according to the drug master data, (e.g. addition of a powder) the system will not take this ingredient into account when calculating the solution quantity.

    End of the caution.

    The system displays an ingredient flagged as a solution in the ingredients table for nutritional solutions in addition to the Solution field.

    • If you do not flag any ingredient as a solution, the recipe quantity is the total of all ingredient quantities that have a unit of the volume dimension assigned.

    • If you flag an ingredient as a Solution, the system automatically calculates the solution quantity by subtracting the total of the ingredient quantities of the dimension volume from the recipe quantity.

    The ingredients are preset from the drug master data.

    Note Note

    Whether you can add, remove or change ingredients, depends on whether the nutritional solution is changeable or not. If a nutritional solution is assigned to a Drug Category, which cannot be changed, you cannot change the ingredients and therefore the composition of the nutritional solution.

    You can also define the ingredients and additives as percentages (e.g. dose of an ingredient is 25%).

    End of the note.

    Note Note

    If you change the recipe of a mixed drug when creating an order, the system always deletes the ordered dose of the mixed drug if you make volume-relevant changes. However, the system will not delete this if you change the dose of an ingredient which is not dosed in a unit of the volume dimension.

    End of the note.

    If you change the ingredients of a mixed drug at the time of the order, or add new ingredients, the system will create the order description according to the following rules:

    • Type of drug category (infusion, nutritional solution or compound)

    • All active ingredients or additives, separated by commas, if no active ingredients or additives exist, all other ingredients, separated by commas

    • The ingredient names (limited to 20 characters); if it is not possible to display all ingredients, the system will display three characters at the end “...” to signal that further ingredient names are contained.

    You can manually overwrite the order description generated by the system in this way. You should note that the system generates a new order description if the ingredients are subsequently changed, and overwrites your manual order description.

  8. Enter the special data for the additives of nutritional solutions on the Ingredients tab page. Note that the same tab pages are available for nutritional solutions as for infusions.

    The additives table corresponds to the table of ingredients. The additives are preset from the drug master data. You can only supplement, remove or add additives if the nutritional solution is changeable.

  9. To add several orders, choose Add Order Add Order (Add Order).

    You access the drug search where you can use the corresponding functions (e.g. multiple selection) to create several orders.

  10. To activate one or more orders, select the order(s) and then choose Activate Orders (Activate Orders).

    See Activating an Order.

  11. To generate the events for one or more orders, select the order(s) and then choose Generate Events (Generate Events).

  12. In addition to the events which the system generates for an order, you can also manually create orders. Choose New Row (New Row) on the Event tab page, to create a new event.

  13. To activate several orders in one work step and simultaneously generate the corresponding events, select the orders in the compressed view and then choose Schedule Orders Schedule (Schedule Orders).

    See Scheduling Orders

  14. You can print the order. Choose Print Order (Print Order).

    The Print Preview screen appears.

  15. Save the order.