Electronic Health Record and Parenteral Nutrition Functionality: A Gap Analysis.

Parenteral nutrition (PN) is a complex, high-alert medication that contains up to 40 different ingredients. Surveys have shown that current electronic health record (EHR) systems may lack functionality for safe and optimal delivery of PN. A gap analysis was performed by a multihospital system to identify opportunities to enhance the current PN process using the EHR utilized by the organization.

Implementation of an insulin therapy protocol: applying the Baldrige approach.

PURPOSE: One quality initiative that North Mississippi Medical Center (NMMC) included in its application for the Malcolm Baldrige National Quality Award (MBNQA) is described. SUMMARY: NMMC is a 650-bed, regional, nonprofit medical center that serves 22 counties in an area with approximately 600,000 people. The hospital received the MBNQA in 2006. NMMC's insulin performance-improvement team recognized a patient safety issue with the use of three insulin sliding scales that did not adequately meet the evidence-based standard of care for diabetes. The team developed a standard sliding-scale order set to enhance patient care and target blood glucose concentrations of 70-120 mg/dL. NMMC's quality initiatives aligned with the seven categories of the Baldrige Criteria for Organizational Performance Excellence-leadership; strategic planning; patient focus; measurement, analysis, and knowledge management; work-force focus; process management; and results. The insulin performance-improvement team included an endocrinologist, nursing staff, information technology staff, and a pharmacist. The goal of the insulin performance- improvement team was to develop a standard sliding insulin scale order set based on literature evidence, clinical knowledge, practitioner feedback, and information technology. The team considered the pharmacy department in the planning and implementation of the project, and pilot programs were conducted to best predict work-force issues. Inservice education was provided to nurses, pharmacists, and physicians over the course of several weeks. The team's attentiveness to time management created a seamless project. The three original sliding scales were discontinued, and the standard NMMC sliding scale was implemented on June 26, 2006. Because the Baldrige approach is versatile and flexible, it helped the insulin performance-improvement team at NMMC meet the challenging demands of health care. CONCLUSION: The Baldrige approach was successfully used to implement a standard insulin therapy protocol.