Authors: (including presenting author): :
Tse HHK(1), Wu SHM(1), Chow TCH(1), Cheng WW(2), Leung JYM(2), Wong JKK(2), Tsang AYK(2), Poon FMH (1), Wong JCL(1), Wong RMS(3)
Affiliation: :
(1)Pharmacy Department, Hong Kong Children's Hospital, (2)Information Technology Department, Hong Kong Children's Hospital, (3)Department of Paediatrics and Adolescent Medicine, Hong Kong Children's Hospital
Keyword 1: :
Parenteral Nutrition
Keyword 2: :
Electronic Prescribing
Introduction: :
Paediatric total parenteral nutrition (TPN) prescribing and preparation are complex and high-risk procedures in a hospital setting. Individualized nutrition needs make TPN use an error-prone process. Traditionally, TPN orders were prescribed on a paper form and faxed to pharmacy for data entry into the computer and aseptic compounding. Lack of computerised clinical decision support, illegible handwriting, and the need for transcribing can all lead to errors and incidents. Between 2019 and 2023, 7 medication incidents related to TPN prescribing and transcribing occurred in HKCH.
Objectives: :
To develop an electronic TPN prescribing and preparation system for mitigating the
risk of medication errors.
Methodology: :
The Pharmacy Department and the IT Department of HKCH collaboratively developed “Smart TPN”, a computerised TPN management system. The program is fully supported by the HKCH Nutrition Committee, which also provide their expertise advices on defining and setting the upper limits within the system. Phase one of the system was a prescribing module that enables doctors to prescribe TPN in a web-based electronic form. To improve continuity of care, the system also allows copying, with or without modification, from the TPN order on the previous day. There are also clinical decision support features in place to improve safety, such as upper limits for each nutrient to alert prescribers if the amount prescribed is above the usual range. Energy content is also automatically calculated to minimize manual calculation.
Result & Outcome: :
The system was piloted from June 2024 and fully rolled out to all non-ICU wards in HKCH in March 2025. As of December 2025, the system has handled over 3700 TPN orders. No medication incident related to TPN prescribing and transcribing has been reported since launch.
Phase two of Smart TPN is a compounding module enabling conversion of TPN orders to ingredient volumes and worksheets for aseptic compounding of TPN bags. The module is also connected to the automatic compounding device in clean room. This phase will eliminate the need for transcribing TPN orders to a separate system, therefore creating a seamless closed-loop TPN workflow. The roll-out is planned for February 2026. In conclusion, Smart TPN enhances medication safety through clinical decision support and accurate communication of patients’ nutritional information. It also eliminates illegible handwritten orders and reduces transcription errors, streamlining the TPN ordering process for safer and more efficient patient care.
