Total Parenteral Nutrition (TPN) and CIVAS  

Functionality

• System is Windows based all inputs can be made via keyboard, mouse and where enabled barcodes.
• All users must have a valid password and associated authorised access to the system.
• Full on line help is available
• Parenteral Nutrition records can either be entered against individual patients or set up for batch production.

Patient Specific Parenteral Nutrition.

Patient details

• Ability to enter and store patient demographic details including:-
• Date of Birth and Age (patient will ‘age’ in the system even if age entered in years without a specific date of birth)
• Dosing weight
• Dosing height
• Surface area can be calculated or entered manually
• Age, weight and height check carried out each time the patient record is accessed to alert users to inappropriate entries. Normally ranges can be amended to suit local policies.
• Notes can be entered against the patient record.

Parenteral Nutrition records

• These form part of the Patient Medication Record (PMR) and are stored either as current or historical records.
• Multiple electronic PN records can be stored against a patient record.
• The system will create records in one or two modes:-
• Neonatal/Paediatric mode is selected either automatically or the user is prompted where the patient meets the required parameters. All requirements can then be selected and entered in terms of /kg and specific neonatal / paediatric options are offered to the user.
• Adult mode is selected either automatically or the user is prompted where the patient meets the required parameters. All requirements can then be selected and entered in terms of totals and specific adult options are offered to the user.

PN requirements can be entered in two ways:-

1. Parenteral Nutrition Prescribing

• Patient requirements can be entered by clinicians, nutrition team members or pharmacy staff, and where network access is provided this can be done at ward level or even at the patient’s bedside.
• The system will allow the following information to be recorded.

Clinical Details

• Details regarding the patient’s clinical condition may be entered, along with general information regarding the patient’s clinician and treatment.

  Prescription Input

• The user can either select a prescription proforma template based on a list appropriate to the patient’s age and weight, or enter a prescription from scratch.
• Any clinical conditions entered in the clinical details section for the patient may advise recommendations to modify the prescription. The user can amend and save changes.
• Facilities exist to scale the requirements up or down by % and nitrogen requirements can also be entered in terms of Amino acid.
• This prescription can then be saved to the patient record ready for pharmacy or compounding unit input.   
• Details or other eternal feeds or other infusions can also be recorded allowing users to compare delivery of key ingredients.

2. Standard Regimens

Alternatively users can enter patient requirements in terms of locally defined standard regimens – i.e. list of products with volumes. For neonates / paediatrics the volumes used can be calculated in the first instance  /kg These regimens once selected for a patient can then be modified in many ways

• By product volume or ml/kg
• By product allowing the user to adjust by any ingredient contained in the product
• By ingredient allowing the user to adjust any product supplying that ingredient
• Overall calorie content while preserving all other ingredients
• Overall volume while preserving all other ingredients
• Replacement products can be swapped in and out while preserving a particular ingredient
• Regimen can be scaled up or down.

Where commercially available bags are used with additives the system can ‘scale’ the additive over the bag volume for correct delivery where only part of the bag will be delivered to the patient. 

Other features

Authorisation stage

Before any documentation can be produced the regimen must be authorised. This step results in a number of regimen validation rules being run against the regimen. This will warn the user where these rules have been exceeded or even prevent the regimen being authorised if ‘critical’ rules have been breeched.

Default settings

Although there are default settings for many parameters relating to the regimen delivery, users can amend specific details regarding these:-

• Specify the route of administration
• Supply as separate aqueous and lipid phases or as an all in one bag
• Period of infusion, allowing the system to calculate flow rates
• Overages per phase or per bag (neonate / paediatrics) 
• Number of labels required
• Batch number format – automatically incremented
• Electrolyte results for the patient can also be recorded and stored by the system for reference.

Documentation

Documents generated are:-

• Worksheets (separate formats can be used for neonatal/paediatric, adult and batch)
• Prescriptions (separate formats can be used for neonatal/paediatric and adult)
• Insert for patient notes (separate formats can be used for neonatal/paediatric and adult)
• Labels (separate formats can be used for aqueous/combined, lipid and lipid syringes)
• Invoices can be generated either using set billing prices for the products used or actual cost prices where full stock management is implemented. Consumable costs and overheads can also be added.

Batch Production

This facility allows regimens to be stored for production as a batch process. This can use the adult standard regimens as a starting point or input a regimen as required.

Printing

All printouts are user configurable in design

Any printer with a windows driver can be utilised and the system can hold settings about which printer is used for which output.

Recommended printers:

• Labels
  Zebra 2844 –direct thermal or thermal transfer modes
• Worksheets etc
  HP2100 Laser printers for sheet printing or any A4 laser printer

Audit trails

All changes to the system are logged with the date and time along with the Users ID. These changes include:-

• Password maintenance
• All changes made to the system setup regarding the PN module
• Editor changes to supporting files.

Stock management and Reporting

Since the PN module forms part of the entire suite of the ascribe medicines management system, where required, the system can maintain all relevant stock details relating to products used in PN manufacture.

The Executive Information System (EIS) can then be used to extract information either as graphs or tables on the main screen, or using SQL along with Crystal ™ reports.

Validation

Ascribe will work with the site to ensure that the users are able to satisfy themselves and the inspecting bodies that the system (software, data, hardware training etc) are validated The system, where networked will normally be set up with a live and training accounts, allowing sites to test and validate new releases of software prior to live operation.

 

CIVAS

Civas - Extemporaneous Manufacturers
Ascribe CIVAS & Manufacturing facilitates the preparation of aseptic products, such as intravenous and cytotoxic medications. The system will create labels and worksheets for a requested product, including formulae, methods and worksheets. The system also facilitates batch production, enabling large quantities of commonly used products to be prepared in one session.