Paediatric Parenteral Nutrition (PN) - PowerForm and eMR Orders

Overview

The Inpatient Parenteral Nutrition order has two components:

1. The Paediatric Inpatient Parenteral Nutrition PowerForm

• Found in the PowerChart AdHoc tab in the General, Gastroenterology, Oncologyy/BMT and ICU folders 
• As the form does NOT auto-generate eMR orders on the MAR, these orders must be placed separately

2. The Parenteral Nutrition and lipid solution eMR orders

• Found in the Paediatric PN PowerPlan
• The PN and lipid solutions volumes as well as the infusion rates must be accurately transcribed from the PowerForm to show correctly on the MAR

This QuickStart will guide you on safe prescribing on PN. The links in the quickstart will cover specific components of the PN PowerForm.

Paediatric Inpatient Parenteral Nutrition PowerForm

Note: If there is blue text and a white box, right-click and select Reference Text to show the associated documentation.

• The inpatient Paediatric PN PowerForm can be found in the AdHoc tab in PowerChart in the general, gastroenterology, Oncology/BMT and ICU folders.  Tick the form and Click Chart.

• When the form launches, patient details will be displayed at the top of the form.

Patient location

• Select location: depending on location, certain fields of the form will become available.

Order date

• Enter the order/prescribing date
• Orders can be placed daily, or multiple orders can be placed for future dates
• If future orders are different, e.g. weekend PN orders, ensure separate orders are prescribed.

Patient’s weight

• The prescriber needs to decide on an appropriate clinical weight to be used
• The system will automatically select vitamins type and amounts based on the patient’s weight.

PN infusion site

• Peripheral PN is to be used at SCH and CHW ICU only. 
• Only the S2-10 solution contains the appropriate osmolarity for peripheral administration.

***SYSTEM LIMITATION*** The system will allow prescribers to click on both central and peripheral sites unless ordering from CHW. Ensure one administration site is selected only.

PN solution order - 3 options

• You must select ONLY ONE of these options to order PN.
  • PN Standard Solution
  • PN Modified Solution
  • Custom PN Solution

***SYSTEM LIMITATION*** The system will allow all three options to be selected simultaneously. Ensure only one option is selected to avoid prescribing errors.  

PN volume and rate calculations - 2 options

***SYSTEM LIMITATION***  At CHW both options are available, please select one (1) option only.

1. Standard volume and rate

2. Cyclical volume and rate

Lipid Emulsions

• Standard lipid emulsion – refers to SMOF (default lipid).
• Alternate lipid emulsion – if Omegaven is required, approval is needed.  Please contact the pharmacy for availability.

NOTE: Ensure that the patient's weight is entered before this section can be completed appropriately.

1. Select Yes or No if the Vitalipid option is required.
   • If the patient is <=5kg Vitalipid will be automatically selected as Yes but you can choose to change the selection if required.
2. Enter the daily amount of lipid in g/kg that is required, the volume of lipid will be automatically calculated.
3. Enter the number of hours the lipid is to be infused over and the rate will automatically be calculated.

• Once the details are entered correctly, the rate in the red box is the lipid rate that should be transcribed to the Paediatric PN powerplan.  This will also appear on the patient’s MAR.

Additives

• Multivitamins will automatically be selected based on the patient’s weight entered.  This option can be deselected in scenarios where vitamins are not indicated
• Trace elements will be automatically selected.  This option can be deselected in scenarios where trace elements are not indicated
• Other additives: this is a free text box, discuss with pharmacy prior to ordering additives to ensure stability and compatibility of the PN solution

Nutritional Breakdown:

***SYSTEM LIMITATION*** the form will not alert the prescriber if the nutritional breakdown values do not fall within the reference ranges in the table below.   The form can still be SUBMITTED and SIGNED despite out of range values.  Review the orders to ensure the breakdowns are clinically appropriate. 

NOTE: Values of GIR and potassium cycling will only appear if Cycling PN is ordered

• Orders will prepopulate from the last time a patient has had an order, please review ALL order components before signing off the form to ensure values are still applicable.

PN PowerPlan Order

• After completing the AdHoc form, proceed to order the PN and lipids eMR orders via the Paediatric PowerPlan
• Ensure the volume of the PN and lipid solutions, as well as the infusion rates are accurately transcribed

Also see

eMM - Ordering Parenteral Nutrition (PN) (including weaning details)