Preposed evaluation software for parenteral nutrition prescription

Abstract

The invention discloses preposed evaluation software for a parenteral nutrition prescription, relates to the field of parenteral nutrition support treatment, and relates to a whole process of parenteral nutrition. The software comprises a medicine database part, a patient information area, a parenteral nutrition prescription area, a substance and energy recommendation and judgment area, a stability judgment area and an infusion mode and time suggestion area. A doctor can be helped to make the most suitable parenteral nutrition prescription according to the information and the illness state of a patient, and the stability after mixing according to the prescription can be guaranteed. And the most suitable infusion mode and the minimum infusion time suggestion are given. Due to the fact that parenteral nutrition ingredients are complex, the requirements for stability and patient adaptability are high, the calculation workload is large, if calculation is conducted through a formula according to the requirement of a guide, time is long, and errors are prone to occurring, the software writes in the calculation formula recommended by the guide, the whole process of parenteral nutrition calculation is achieved, and energy intake standards, electrolyte intake standards and intake standards of all nutrient substances are included. And the stability is judged, a plurality of different calculation modes are provided, and more choices are provided.

Description

TECHNICAL FIELD

[0001] The present application relates to the field of parenteral nutrition support treatment, including the determination of whether the recommended combination of nutrients meets the recommendations, the determination of stability, and the selection of infusion method and infusion time. Each calculation step is made into a formula and brought into excel for automatic operation, saving the work of manual step-by-step calculation. BACKGROUND

[0002] Clinical nutrition support treatment has always been an important part of clinical treatment. There are two ways of enteral and parenteral nutrition support. When the gastrointestinal function is seriously impaired, parenteral nutrition (PN) can provide the nutrients required by the body, promote patient recovery, and improve patient prognosis. Some patients can even rely on it for survival. Since the 1970s, with the continuous improvement and update of new concepts in the field of nutrition support treatment, medical institutions across the country have increasingly valued the standardized management of parenteral nutrition. The nutrition support team (NST) composed of physicians, pharmacists, nutritionists, nurses and other related medical workers and other interdisciplinary professional and technical personnel guides the various aspects of nutrition support treatment with standardized processes, and optimizes the comprehensive management of nutrition-related management. It has become a new direction of clinical nutrition support treatment.

[0003] Parenteral nutrition mainly contains three nutrients: fat emulsion, amino acid, and glucose. From the perspective of preparation, glucose, amino acid, and fat emulsion are mixed together, other nutrients are added, and then placed in a bag for infusion, which is called an "all-in-one" system (All-in-One, AIO). The American Society for Parenteral and Enteral Nutrition (ASPEN) calls it total nutrient admixture (TNA). During its use, stability and compatibility need to be considered. There are many factors that affect the stability and compatibility of total nutrient admixture, such as electrolyte depth, glucose concentration, amino acid concentration, fatty acid composition, calcium and phosphorus precipitation, pH value, temperature, etc. Viewing various patents, the energy calculation is relatively simple, and it does not consider the energy demand calculation for different groups of people, such as critically ill patients, obese patients, and patients who need to prevent re-feeding syndrome. The energy demand and the proportion of various components of nutrients are different for different situations of patients, and most of them only consider nutrition support, without considering the stability of total nutrient admixture, which is undoubtedly disastrous for clinical treatment.

[0004] Different medical professions consider different factors, such as physicians and nutritionists only consider nutritional needs, not the stability of mixed drugs, and nurses need to consider infusion time and infusion method. Now, medical units have introduced pre-examination prescriptions or static configuration center prescriptions, but they cannot directly give suggestions and only return to the clinical physician for repeated modification when the prescription is unqualified. The present application connects each link, provides nutritional suggestions and stability judgments, and makes subsequent processes reasonable at the physician end. SUMMARY

[0005] The purpose of the present application is to connect each link of parenteral nutrition support treatment and solve all problems at the physician end. Through analysis of patient information, the most suitable nutritional suggestions are given, which solves the trouble of repeated modification of parenteral nutrition prescriptions by physicians and can guide nurses to select appropriate infusion methods and infusion time.

[0006] The present application refers to the "China Adult Patient Parenteral and Enteral Nutrition Clinical Application Guide (2023 Edition)", the "Guangdong Province Pharmaceutical Society Parenteral and Enteral Nutrition Clinical Pharmacy Practice Consensus (2022 Edition)", and the "Parenteral Nutrition Clinical Pharmacy Consensus (Second Edition)" (issued by the Guangdong Province Pharmaceutical Society on April 18, 2017).

[0007] The present application is divided into six parts: drug database part, patient information area, parenteral nutrition prescription area, substance and energy recommendation and judgment area, stability judgment area, and infusion method and time suggestion area. Figure 1 、 Figure 15

[0008] Drug database part: used for maintaining drug information for parenteral nutrition, adding mainstream parenteral nutrition drugs, adding key fields for calculation (must be maintained), providing the right of users to add and maintain drugs, each field is intuitive and visible, which is beneficial for maintenance, and the well-maintained drugs can be retrieved and selected after inputting the key in the prescription area.

[0009] Patient information area: contains patient name, gender, age (years), height (cm), weight (kg), whether obese, whether critically ill, prevention of feeding syndrome (set nutritional percentage), obese patient corrected weight, activity index, and stress index. The information in this area is used for later calculation and should be as accurate as possible.

[0010] Parenteral nutrition prescription area: input the key to retrieve the already maintained drugs and select them in the table, and then write the dosage in the dosage position, which is in ml unit. These data are used to calculate the total volume of parenteral nutrition, and the dosage, proportion, and concentration of various nutrients and electrolytes are calculated according to the dosage of selected drugs.

[0011] Substance, Energy Recommendations, and Judgment Area: This area lists the main energy and substance recommendations, provides "reference values" according to guidelines, calculates the "values" in the parenteral nutrition prescription, and provides an "evaluation." The "reference values" for carbohydrates, fats, and amino acids are recommended based on body weight and are related to data in the "Patient Information Area." The "values" are a categorized summary of the substances included in the parenteral nutrition prescription. The "evaluation" compares the values ​​of each substance with the reference values ​​to generate an evaluation result. Appropriate energy calculation methods can be selected as energy references in this area.

[0012] Stability Assessment Area: This area is used to assess the stability of parenteral nutrition after mixing according to the prescription. It only considers a few of the most easily controlled parameters: Na+ (mmol / L), K+ (mmol / L), Ca2+ (mmol / L), Mg2+ (mmol / L), P (mmol / L), concentrations of monovalent cations (Na+, K+), concentrations of divalent cations (such as Ca2+, Mg2+), final amino acid concentration, and final glucose concentration. The reference values ​​are the values ​​recommended in the guidelines. If the values ​​calculated based on the parenteral nutrition prescription do not conform to the reference values, a warning will be given. In particular, if the electrolyte concentration or the final glucose concentration exceeds the upper limit, an assessment that may affect stability will be given. When the final amino acid concentration is lower than the reference value, an assessment that may affect stability will also be given. If the phrase "may affect stability" appears in any of these assessments, the conclusion of stability is "may be unstable," and a warning will be given with a red background.

[0013] Infusion Method and Timing Recommendations: This section calculates the total volume, osmotic pressure, and minimum infusion time for parenteral nutrition prescriptions, providing recommendations for appropriate infusion methods and timing. Two osmotic pressure options are provided, using formula 1 (calculated based on the components of an industrial three-chamber bag, the results of which are similar to those in the product instructions): Osmotic pressure (mOsm / L) = [Glucose (g) ×5 + Fat (g) ×1.5 + Amino acids (g) ×10 + Alanylglutamine (g) ×5 + (2NA + 2K + Mg + 1.4Ca + p)(mmol) + Trace elements (ml) ×19 (mOsm / vial)] / Total volume (L). Osmotic pressure formula 2 (calculated using industrial three-chamber bag components; the result differs significantly from the product instructions): Osmotic concentration (mmol / L) = (9.66A + 7.88G + 3.52F + 36.4Na + 27.55K + 3.38P + 7.46W - 250) / V; where A is amino acids (g), G is glucose (g), F is fat emulsion (g), Na is sodium chloride (g), K is potassium chloride (g), P is phosphorus in sodium glycerophosphate (g), W is trace elements (ml), and V is total volume (L). The total volume is the sum of the volumes of all medications in the prescription. Reference values ​​are provided, calculated based on the patient's age and weight. Since the patient may have used other fluids, only reference values ​​are provided here, without evaluation.

[0014] Liquid volume calculation method Attached Figure Description

[0015] Figure 1 Calculate the partition map for this software. Figure 2 After all patient information has been entered, Figure 3 Enter the keyword "fat emulsion" in the parenteral nutrition prescription area to see the options. Figure 4 Select the required medication and enter the dosage. Figure 5 The parenteral nutrition prescription section has been edited. Figure 6 Select the recommended energy usage measurement method. Figure 7 After selecting the measurement method, the software evaluates the energy in the prescription. Figure 8 Based on the prescription, the evaluation results provided by the substance and energy recommendation and judgment area. Figure 9 Amino acid correction in obese, severely ill patients Figure 10 Warning when potassium concentration exceeds the maximum allowable value Figure 11Warning: Mixed parenteral nutrition may be unstable. Figure 12 Stability after parenteral nutrition is combined Figure 13 Choose different osmotic pressure calculation formulas Figure 14 Difference in minimum infusion time between critically ill and non-critically ill patients Figure 15 Drug Database Section Detailed Implementation

[0016] Enter the correct patient information in the patient information area. The patient's energy requirements will be calculated based on this information. Enter the patient's name, select gender (male or female), age, height, weight, and whether it is severe or non-severe, obese or normal, and whether it is normal feeding or prevention of refeeding syndrome. If prevention of refeeding syndrome is selected, the nutritional percentage needs to be manually entered; for example, if the nutritional percentage is 50%, enter 50. Select the activity index and stress index. The energy intake standard used in this study employs the guideline-recommended thumb rule and TEE = Basal Energy Expenditure × Activity Index × Stress Index. The thumb rule calculates energy requirements based on the patient's weight. For obese patients, the requirement needs to be corrected based on their height, and the energy requirement is calculated using the corrected weight to prevent overfeeding. TEE = Basal Energy Expenditure × Activity Index × Stress Index is calculated using the patient's height, weight, age, activity index, and stress index. The parameters required for this calculation are displayed in a drop-down menu for ease of calculation. The calculated energy intake will be used as the standard for normal feeding.

[0017] After the patient information is entered, as follows Figure 2 As shown.

[0018] In the parenteral nutrition prescription area, enter keywords for the parenteral nutrition drug in the drug name column. Click the small triangle to the right of that row; drugs containing the keyword will appear. Select the desired drug. For example, entering "fat emulsion" will display all drugs containing "fat emulsion." In this case, select "Fat Emulsion 10% / Amino Acid 15% / Glucose 20% Injection __ 1500ml". Figure 3 .

[0019] After selecting the medication, enter the dosage in the dosage column. This can be any number, and the basic dosage unit is ml. The dosage used this time is 1500. For example... Figure 4

[0020] After selecting the required medications, the work in the parenteral nutrition prescription area is complete. Figure 5 The software will evaluate the prescription, at which point it will redirect to the material and energy recommendation and judgment area.

[0021] Choose the recommended energy level (select the measurement method), including the thumb rule and basal energy expenditure × activity index × stress index. After selection, the system calculates the energy requirement. If the patient information area has a nutritional percentage for preventing refeeding syndrome set, the system will calculate the percentage based on the result, and the resulting value will be used as a reference value for the patient's nutritional assessment. Figure 6 .

[0022] The total energy (kcal) value is calculated by adding the energy from amino acids, fat emulsion, and carbohydrates in the parenteral nutrition prescription and comparing it to a reference value. This serves as a warning in case of malnutrition or overnutrition. In this case, the thumb rule was used: if the energy in the parenteral nutrition prescription exceeds the reference value, the evaluation will indicate "overnutrition." Figure 7 .

[0023] Calculate the components in the parenteral nutrition prescription according to the items listed in the column, and compare the results with reference values. If the values ​​are lower or higher than the reference values, a corresponding warning will be given in the evaluation. For example, in this parenteral nutrition prescription, the calorie-to-nitrogen ratio, amino acids, and sodium... + K + Mg 2+ Low, such as Figure 8

[0024] When evaluating amino acids, it's important to note that critically ill patients have higher amino acid requirements than non-critically ill patients. Amino acid recommendations are divided into standards for critically ill and non-critically ill patients. Some international guidelines indicate that for obese critically ill patients, amino acid recommendations should be based on ideal body weight. If amino acid correction is selected, the reference values ​​will be adjusted to the corrected body weight, and the reference values ​​will change. Figure 9 .

[0025] If alanine-glutamine is included in a patient's prescription, an evaluation will be conducted if its dosage and concentration are inappropriate; no evaluation will be conducted if this ingredient is not present. Potassium is a high-alert medication; its use is assessed not only for dosage but also for concentration. If the potassium concentration in a parenteral nutrition prescription exceeds the maximum permissible concentration for central venous infusion, a warning message indicating excessive potassium concentration – use prohibited will be displayed, and a red background warning will be given during the evaluation. Figure 10 .

[0026] Based on the above evaluation, the doctor can revise the parenteral nutrition prescription again. Once the evaluation shows no abnormalities, the patient can proceed to the stability assessment area.

[0027] This area is used to assess the stability of parenteral nutrition after mixing according to the prescription. It only considers a few of the most easily controlled parameters: Na+ (mmol / L), K+ (mmol / L), Ca2+ (mmol / L), Mg2+ (mmol / L), P (mmol / L), monovalent cation (NAK) concentration, divalent cation (such as Ca2+, Mg2+) concentration, final amino acid concentration, and final glucose concentration. The reference values ​​are the values ​​recommended in the guidelines. When the values ​​calculated based on the parenteral nutrition prescription do not conform to the reference values, a warning will be given, especially when the electrolyte concentration and final glucose concentration exceed the upper limit, indicating a potential impact on stability. When the final amino acid concentration is lower than the reference value, a potential impact on stability will also be given. If the phrase "potentially affects stability" appears in any of these evaluations, the stability conclusion is "potentially unstable," and a warning will be displayed with a red background. In this case, prescription adjustments are required based on the items that may affect stability. When the software determines that the system is unstable, a prominent warning with a red background will be displayed in the conclusion area: "potentially unstable." Figure 11 .

[0028] Conversely, if the conclusion is stable, a green background is used. For example... Figure 12

[0029] When the conclusion is stable, proceed to the section on infusion method and timing recommendations.

[0030] Parenteral nutrition is administered intravenously. Depending on its osmolality, peripheral or central veins can be chosen. When the osmolality is >900 mOsm / L or the potassium concentration is >30 mmol / L, only central vein administration is possible. Parenteral nutrition prescriptions are complex, and osmolality varies considerably, making calculations complicated. This guideline provides two osmolality calculation formulas for reference. Different osmolality formulas yield different results, such as... Figure 13 .

[0031] Parenteral nutrition infusion time is relatively long, and the longer the infusion time, the higher the possibility of infection. Therefore, a minimum infusion time is introduced. The minimum infusion time is greatly affected by the final glucose level. Minimum infusion time (h) = total glucose (g) × 1000 / body weight (kg) / 4~5 (mg / kg / min) / 60. For the most critically ill patients, the minimum infusion time (h) = total glucose (g) × 1000 / body weight (kg) / 3~4 (mg / kg / min) / 60. This calculation has already taken into account whether the patient is critically ill. You need to select whether the patient is critically ill in the "Patient Information Area". For the same prescription, the minimum infusion time is different for critically ill and non-critically ill patients. Figure 14 .

Claims

1. Pre-prescription evaluation software for parenteral nutrition. This invention is divided into six parts: drug database, patient information area, parenteral nutrition prescription area, substance and energy recommendation and judgment area, stability judgment area, and infusion method and timing suggestion area. Editable areas in each section are shown in green, while gray areas are non-editable.

2. When using this software, the drug database must be maintained correctly, and the content of each field must be accurate. Drug name, specifications, liquid volume, fat, amino acids, alanine glutamine, glucose, nitrogen, Na+ (mmol), K+ (mmol), Mg2+ (mmol), Ca2+ (mmol), P (mmol), volume of various trace elements, and long-chain fat emulsion—if any of these items are present in the drug, they must be maintained.

3. The information in the patient information area should be accurate, as this is the basis for calculating the patient's parenteral nutrition intake. When preventing refeeding syndrome, a percentage must be set, and its value can be any number from 0 to 100.

4. The dosage of the selected medication in the parenteral nutrition prescription area must be entered. If it is blank, the dosage of the medication will be considered as 0. Columns with non-zero dosages must contain medications; otherwise, the volume of parenteral nutrition solution will be increased out of thin air, which will affect subsequent evaluations.

5. The software's calculation interface only allows editing of the green area, but the green area used for stability assessment cannot be edited.

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