ABSTRACT
The COVID-19 pandemic represented a substantial risk to the continued supply of compounded home parenteral nutrition (HPN) to patients with intestinal failure. NHS England requested that all patients receiving HPN have a contingency prescription that could be supplied if their homecare provider weren’t able to supply their compounded prescription. The formation of contingency prescriptions and subsequent communication of the plan to both the patients and those involved in their care, was a significant undertaking. Could technology aid in the formation of the contingency prescriptions, improve communication between members of the multidisciplinary team (MDT) and standardise the accompanying written administration plan? An existing spreadsheet developed in-house was used which contained all the commercially available multi-chamber bags (MCBs) and terminally sterilised fluids (TSFs) on the market. A deficits tab was added to the workbook that calculated the weekly differences between the patient’s usual compounded prescription and a proposed contingency prescription. Drop down menus auto populated the contents of the MCBs and TSFs into the spreadsheet. This tab was printed, reviewed by other members of the MDT and was risk-assessed. A tab was created which transferred the selected MCBs and TSFs onto a contingency template to send to homecare providers. This included custom instructions e.g. drug name, dose/volume, form, directions/frequency and total supply per week. Patient information was copied from the compounded formulation request and pasted into the contingency template. The template could then be exported to a separate document, allowing additions of line locks / other medication usually on the prescription. A further tab facilitated the production of a written administration plan for the contingency regimen. Patient information was auto populated from the order template, while drop down menus restricted the bags used to only those that had been selected on the deficits tab. Custom administration instructions were auto populated into the plan. A table showed how many of each bag per week are required, and this counted down as the written plan was populated. Once the written plan was populated, the spreadsheet calculated the number of each type of ancillaries required each week. A breakdown of daily calories and electrolytes supported the user in spreading the prescription as equally as possible across the week. Further alterations were made using an export function prior to sending to the patient and the homecare provider. The development of this spreadsheet has significantly improved the efficiency of the process for creating contingency prescriptions for patients on compounded HPN and produced a robust method for communicating the proposed regimen between members of the MDT. It has successfully standardised our wording on the contingency order templates and written administration plans whilst eliminating transcription errors.