B. Braun’s PINNACLE TPN Management System


October 2008 - Vol. 5 No. 10

Licensed for approximately 300 beds and located in San Bernardino, California, Community Hospital of San Bernardino is a non-profit, full-service, acute-care facility providing acute inpatient care, long-term care and a range of outpatient, ancillary and therapeutic care. We typically handle about 10 TPNs a day in our certified cleanroom and recently purchased and implemented B. Braun’s Pinnacle TPN Management System to help reduce the time required for TPN formulation and preparation while also enhancing patient safety.

The Challenge
We wanted to tailor the TPN to each patient and were looking for a compounding system that would allow us to do this. This is especially important when dealing with more complicated patients, such as renal patients. We were looking for enhanced performance but our biggest concern was patient safety.

It was a relatively smooth transition to the Pinnacle system. In implementing the system, we found it simple to connect the interface between Pinnacle and our PIS because the Pinnacle compounder acts like its own server. It basically hooks up to our computers within the pharmacy department while the computer in the IV room runs the Pinnacle program and everything runs directly off that. It wasn’t challenging or difficult; we were up and running in one afternoon.

The Solution
With the Pinnacle system, our pharmacists write the orders on the charts at the different nursing units and scan them down to the pharmacy where they are printed out. The pharmacist then enters the patient-specific order into the Pinnacle program, which helps to formulate the entire TPN. We just punch in the electrolytes and the nutrients needed, and indicate central or peripheral line. The program makes the calculations according to our parameters. We then print out a sheet listing all of the additives, which a second pharmacist checks for accuracy. At that point, the technician begins the compounding process.

In the compounding room, the technician scans the 2-D barcodes on the order sheet, which queues and pumps the pre-hung macro-nutrients (i.e., lipids, dextrose, sterile water, amino acids) and they manually draw up any other additives (such as electrolytes and calcium) specified on the order. The pharmacist comes in at this point to verify the amounts. This is a very straightforward process as neither the technician nor the checking pharmacist needs to make any calculations; the compounder has already done this. Lastly, the Pinnacle generates two sets of labels: one for the chart and the other to attach to the bag.

The system has safety warnings to alert you before you even get to the compounding room. It alerts you if any of your limits are exceeded. For example, if the chloride is too high, or if you exceed your volume, you will be alerted. There are also warnings such as aluminum content for neonates on long-term TPN that we are able to monitor. This all happens at the order-entry phase, which allows the pharmacist to address any issues immediately. In addition, there is an alert when an additive runs low.

The Result
Using the Pinnacle system to compound our TPNs has given us peace of mind because of its accuracy. We are confident that the calculations and the measuring are completely accurate. An excellent feature is the graphical display of orders: initial additives are shown in one table and an adjacent table shows your requested changes, highlighted in yellow. Our pharmacists appreciate this display as it makes it easy to enter orders and make any adjustments.

Conclusion
Implementing the Pinnacle compounder was simple and the staff has been very receptive. It has allowed us to measure our TPN doses more accurately and has reduced the time required for TPN preparation. And most importantly, it has enhanced patient safety, which is always our most important goal.

 



Brian Amador, PharmD, earned his Doctor of Pharmacy degree from Western University of Health Sciences in Pomona, California and after starting at Community Hospital of San Bernardino as an intern and staff pharmacist, has worked as their lead clinical pharmacist for the past two years.

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