Increased parenteral nutrition calcium and phosphorus for very-low-birth-weight infants using computer software assisted ordering.

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Abstract
Providing adequate calcium (Ca) and phosphorus (P) in an appropriate ratio to preterm very-low-birth-weight (VLBW: BW < 1500 g) infants receiving parenteral nutrition (PN) is difficult because Ca:P solubility in PN is relatively low. Computer software assisted ordering (CSAO) was developed to integrate PN Ca:P solubility with clinical data to improve parenteral Ca and P administration. Our hypothesis was that CSAO would improve the system of designing PN by increasing the amount of Ca and P ordered without Ca:P precipitation. Control PN orders were designed using proprietary preprinted PN forms which incorporated predefined PN Ca and P concentrations to prevent precipitation, independent of patient Ca or P administration. CSAO assessed total daily fluids and correlated parenteral volume with Ca:P solubility during order entry to recommend daily Ca and P doses. PN orders which provided > or = 80% of total nutrition volume as PN were analyzed. PN was designed with more Ca (60.3 +/− 16.7 mg/k/day, mean +/− 1 SD) and P (32.8 +/− 13.9 mg/k/day) using CSAO compared to control group Ca (50.0 +/− 17.1 mg/k/day) and P (25.1 +/− 9.1 mg/k/day), both Ca and P, p < 0.001, CSAO provided > or = 80% of the minimum recommended daily Ca in 82% of PN orders compared to 51% of the control orders, p < 0.001. No PN mixture demonstrated Ca:P precipitation. The system of designing PN was improved using computer software assisted ordering indicated by increased PN Ca and P content without Ca:P precipitation.

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