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User’s Manual

Marvin Medi-Soft, LLC

Website: www.TPN2000.com

Email: admin@tpn2000.com

Direct: 480-588-2190

Toll Free: 1 (877) TPN-EASY

TPN 2000-N

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1. Installing TPN 2000-N program

• Computer requirements 1

2. Opening TPN 2000-N program 2

3. START PAGE 2

4. TPN ENTRY PAGE 3

• Sections 4

• TPN Data Entry 4

• Laboratory values 7

• Preview Window 8

• Suggestion Box 9

• Enteral Feeds 10

• Non-TPN IV Infusions 11

• Cycling TPN 13

• Amphotericin B 14

5. PRINT PAGE 15

6. DRIPS PAGE 17

7. NUTRITIONAL CONSULT PAGE 19

8. FORMULAS PAGE 21

9. CALCIUM PHOSPHORUS SOLUBILITY PAGE 23

10. CUSTOMIZATION PAGE 24

11. Closing and Saving TPN 2000-N Program 25

12. Customer Support

CONTENTS

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Computer requirements (will be updated regularly based on latest IT specs)- MMS will provide latest requirements as necessary:

• Microsoft Excel 2007 or higher is required to run TPN 2000

• Microsoft Windows 7 or higher (minimum to support Excel version)

• PC with Pentium processor (2.0 GHz or higher preferable),

• RAM free 128 MB- 2GB or higher. An additional 8 MB of RAM disk space

• Monitor resolution minimum 600x800, and printer.

TPN 2000-N is installed on your computer in 3 short steps.

Step A: Create a new folder on your hard drive/Network drive and name it “Tpn” Step B: Copy the file named “_Blank_TPN (or Demo TPN)” from the downloaded folder or

from a location on your hard drive to the “Tpn” folder.

Step C: Create a shortcut icon for “Tpn” folder on your desktop Each of the three steps is described in details below.

INSTALATION PROCEDURE Step A: Create a new folder named “TPN”

1) Close all other open programs 2) Open ‘My Computer’. (double click on icon) from the desktop and double click on the

drive where you want to create the new “Tpn” folder 3) Create a new folder on the selected drive and name it “Tpn”: (Single click ‘File’ on

menu bar, Click ‘New’, click ‘Folder’). Change the name of the folder from ‘New Folder’

to “Tpn”

Step B: Copy and Paste the _Blank TPN / Demo TPN file to the “TPN folder” 1) Open folder where the _Blank TPN or Demo TPN file is located. (double click on the

drive. This will display TPN 2000-N file named “_Blank TPN / Demo TPN”) 2) Copy file “_Blank TPN/Demo TPN” (Right click on “_Blank TPN / Demo TPN” and

left click ‘Copy’)

3) Open the drive which contains the newly created “TPN” folder. (Double click on the selected drive)

4) Paste “_Blank TPN / Demo TPN” file to “Tpn” folder. Right click on “TPN” folder, and left click ‘Paste’.

5) Make the file “Read Only”: (Right click on file “_Blank_TPN / Demo TPN”, Click

“Properties”, under “Attributes”, place a “Read Only”

Step C: Create a Shortcut icon for “Tpn” folder on the desktop 1) (Right click on “TPN” folder, click ‘Send to’, click ‘Desktop’ (create shortcut))

Begin using the program: Close ‘My Computer’ box. You have now successfully installed the TPN 2000-N program on your computer (or network) in a folder named “Tpn”. To begin

using the program, proceed with instructions for opening TPN program (see next page).

INSTALLATION

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1. Close all other open programs not currently being used

2. To start a new patient, double click on “_Blank_TPN”. If you have already used the program to enter patients, the TPN folder will display the “_Blank_TPN” file along with other

patient files. To open an existing patient, double click on the file with the patient’s name.

On opening the TPN file, the following box will be displayed.

(Excel 2007) (Excel 2013)

Next the password box is display

Double Click ‘TPN’ icon on the desktop to open the TPN folder

1. Enter password when prompted

(password is case sensitive

! Check the CAPS lock key on the keyboard

OPENING TPN 2000 PROGRAM

“C:\MyDocuments\Excel\BlankTPN.xls” contains macros

Click ‘Enable macros’ (or Yes) when asked to enable/disable macros

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The “START” page is the first page displayed on opening the program

START PAGE: FEATURES AND FUNCTIONS

1. To begin using the program click on Click here to Begin button. This will

take you to the next page/tab, labeled “TPN Entry”

2. To Save and Close the program after TPN order has been completed, click

the “Close/Exit button”

3. Click on the website, www.tpn2000.com to visit TPN 2000 home page, or

click on admin@tpn2000.com to send an email question or suggestion

Navigate to other pages in the program by using the named tabs displayed at the lower

edge of the Start page

Eight tabs corresponding to eight ‘PAGES’ appear at the bottom of the screen as shown above. Click a tab to go to each of the eight pages

Click to proceed to TPN Entry page

Click to visit TPN 2000 website for support and information

Correctly identify patient by name and MR No.

START PAGE

www.tpn2000.com

admin@tpn2000.com

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SECTIONS of TPN ENTRY PAGE Before proceeding with data entry, please familiarize yourself with different sections

on the TPN entry page. This page is divided into two main sections, with subdivisions in each section.

• Upper Section is the ‘PREVIEW WINDOW’ which displays a detailed grid containing

information about TPN, Enteral feeds and Non-TPN IV infusions. At the lower right side, the Preview Window contains the ‘ERROR BOX’ for displaying critical errors or incomplete

entries, and immediately belowit, the ‘SUGGESTION BOX’, which displays suggestions to rectify the errors.

• Lower Section is the TPN DATA ENTRY area, and consists the following areas.

1) PATIENT DEMOGRAPHIC DATA entry,

2) SEVEN COLUMNS for entering seven days of TPN ADDITIVES. Each column has a narrow gray column for entering laboratory values next to each TPN additive

3) ENTERAL FEEDS SECTION for entering feeding orders 4) NON-TPN IV infusions for entering details of infusions such as Arterial line, Dopamine

infusion etc

5) CYCLING and AMPHOTERICIN-B functions (see below for details)

PREVIEW WINDOW

TPN AND LAB DATA ENTRY AREA

ERROR BOX

SUGGESTION BOX

Navigation buttons

TPN ENTRY PAGE

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A) DATA ENTRY: GENERAL INSTRUCTIONS • To enter data in a box/cell, click the mouse on the cell to select it (Selected cell assumes

a bold outline see figure below) • To move from cell to cell use the ‘Enter’ key OR arrow keys (down, up, right, left), OR

use the mouse to click and select any cell.

• A help box (OR) assistant (see figure below) opens up whenever a cell that accepts user

input is selected. Instructions displayed in the help box assist with data entry. If the help

box is obstructing the area of work, it can be dragged away to allow unobstructed data entry (Click on the help box with left mouse button and drag with the button clicked).

• Additional help: Usual ranges of additive amounts used in TPN are displayed next

to the name of the additive to provide help with data entry. Some cells contain additional helpful information as ‘Comments’ and are identified with a red mark (see figure below).

To display the comment box, simply position (hover) your mouse over the cells with a red mark, (no need to click on the cells). Moving the mouse away from the cell will cause the

comment box to disappear.

• Error Alerts: In addition to the help box/assistant which traps invalid entries, the

program monitors for other errors or incomplete entries (such as Calcium phosphorus

precipitation, hyperosmolar solutions in peripheral lines etc). These error messages are displayed in the ‘ERROR BOX’ (see ‘PREVIEW WINDOW’ at the top of the page). During

data entry check the messages that appear in the ‘ERROR BOX’ for additional help.

• Data entry is permitted ONLY in cells meant for user input. Entering data in other

cells will result in an error message. If the data entered is invalid or outside set limits, the help box will display an error message and require the user to change the entry. Click

‘Cancel’ to delete the invalid entry and enter a new valid.

Compounding Error identified

Suggestions provided to correct above error

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• Error Alerts: In addition to the help box/assistant which traps invalid entries, the

program monitors for other errors or incomplete entries (such as Calcium phosphorus

precipitation, hyperosmolar solutions in peripheral lines etc). These error messages are displayed in the ‘ERROR BOX’ (see ‘PREVIEW WINDOW’ at the top of the page). During

data entry check the messages that appear in the ‘ERROR BOX’ for additional help.

• Data entry is permitted ONLY in cells meant for user input. Entering data in other

cells will result in an error message. If the data entered is invalid or outside set limits, the help box will display an error message and require the user to change the entry. Click

‘Cancel’ to delete the invalid entry and enter a new valid.

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B) TPN DATA ENTRY

• Start by entering Patient data such as ‘Patient’s name, DOB, Medical record number up

to Physician pager/phone number. (follow Yellow highlighting of cells as a guide to

moving from one cell to the next) • Next enter TPN data in the first of the seven columns (first column will be yellow

highlighted). Begin with ‘TPN Date’, ‘TPN Day Number’, ‘Current Weight’ and proceed all

the way to the end of the column.

• Enter laboratory values if available, in the gray boxes adjoining the cells for TPN additives

wherever applicable. • Certain cells such as venous access, Cysteine, Heparin, Name of Enteral formula etc have a

drop down list of items from which the user makes a selection. To open the list for

selection, click on the down arrow on the right side of the box and click on the desired item to select it.

• Be certain to proceed from top to bottom of each column to make sure that all boxes have

appropriate entries as needed. • Check the ‘PREVIEW BOX and ‘ERROR BOX’ to scan the TPN orders and correct errors if any.

• Just below the preview box is a row of buttons. Click the ‘LABS’ button to see the

recommended laboratory-monitoring schedule.

• Click the ‘SUGGESTION’ button to go to the ‘SUGGESTION’ section at the bottom of the page.

Preview suggestion in this section.

ENTERING LABORATORY VALUES

Laboratory values monitored during TPN therapy can be directly entered next to the corresponding additive (in the gray boxes).

E.g. Serum glucose value is entered next to the Dextrose % ordered in the TPN.

This provides a quick reference to help in deciding the amount of TPN additive based on laboratory values as well as to follow laboratory values serially.

The program automatically color codes the entered laboratory data to facilitate easy identification of normal (gray), low (blue) and high (pink) values. It is important to enter all available

laboratory values as some of the suggestions generated by the program are based on the

laboratory values entered.

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PREVIEW WINDOW

The preview window is always visible and remains fixed at the top of the ‘TPN Entry’ page (does not move with scrolling up or down).

It displays comprehensive information on TPN, Enteral Feeds and Non-TPN IV infusions regarding fluid, calorie, Protein, Sodium and Glucose Infusion Rates from each source.

In addition, distribution of calories, Non-Protein calorie to Nitrogen ratio, Calcium

Phosphorus ratio and Osmolality of TPN solution are also displayed. The preview window provides a useful tool to see the effect of altering various TPN components on

the final order. Use to ‘Preview Window’ to see how changing any one component of the TPN affects the total fluid, electrolyte and nutrition goal of the patient.

The previous day’s values are displayed below current TPN values to provide for easy comparison

with current TPN. On the right lower section of the Preview Window is the ‘ERROR BOX’ which displays alerts and

critical messages. Immediately below it is the ‘ERROR CORRECTION BOX’, which displays the corresponding solution to rectify the error. This function provides immediate feedback regarding

alerts and errors which may need correcting and suggestions on how to correct these. At the bottom of the preview window are buttons which can be clicked to access special functions

or to go to other pages. These include

Printout, Labs, Suggestions, etc. (see figure above)

SUGGESTION BOX When to use the suggestion box

After entering all TPN data and correcting critical errors if any, check the Suggestion box for useful

suggestions just before printing the final TPN order.

How to use this function

Click on the ‘Suggestions’ button located in the lower section of the Preview Window to access the Suggestion Box. Scroll through the entire box to ensure that all suggestions are read.

Modifications to the TPN order may be made based on the suggestions if considered appropriate

for the patient. The suggestions should not be considered as standard practice guidelines and decisions regarding the final TPN order are the SOLE RESPONSIBILITY OF THE

ORDERING PHYSICIAN.

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How does the program compute this function

The suggestions displayed by the program are based on a number of variables which include, patient data, laboratory values, and TPN, Feeding and IV infusion data entered by the user.

Example of Suggestions

1. “Calcium:Phosphorus ratio less than 1:1(optimum). Suggest increase Calcium and/or decrease Phos if indicated.”

2. “Non-protein cal:Nitrogen ratio > 200, may increase Protein if no contraindications”

ENTERAL FEEDS When to use the Enteral Feeds Section

Use this section if patient is to receive Enteral feeds along with TPN infusion.

How to use this function

Enter the volume of each feed, number of feeds per day (e.g. enter 24 if on continuous

feeds, OR enter 8 if on every 3 hourly feeds) and the caloric density of the formula (calories/ounce). Next select the name of the formula from the list displayed by clicking on the

down arrow on the right side of the box. Make sure that the caloric density of the formula

selected, matches the caloric density entered. A brief description of the special features of the selected formula appears next to the name of the formula.

See information on the ‘FORMULAS PAGE’ for modifying caloric densities of formulas and adding enteral supplements to the formulas. How the program computes this function

Since TPN 2000-N is a comprehensive fluid management program, the volume of enteral feeds is

subtracted from the total fluid goals entered.

e.g. Total fluid goal = 100 ml/kg/day

Enteral feedings = 25 ml/kg/day TPN volume adjusted by the program to 75 ml/kg/day to keep the total at 100 ml/kg/day.

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The calories from enteral feedings are added to those from TPN to display total caloric input from

all sources in the ‘PREVIEW WINDOW’. NOTE: Nutrients and electrolytes from feeds are ADDED to the goals entered for TPN

(AND NOT SUBTRACTED)

e.g. Total Na goal entered in the program = 5 mEq/kg/day Na received from Enteral feeds = 1.3 mEq/kg/day Total Sodium received by patient = 5 + 1.3 = 6.3 mEq/kg/day (Thus the Sodium from feeds is in addition to the Sodium from TPN. This is true for all other

enteral nutrients and additives). To see a detailed input of each nutrient and additive from TPN and Enteral source go to

‘FORMULAS PAGE’

NON-TPN IV INFUSIONS: When to use the NON-TPN IV INFUSIONS function

Use this function for patients receiving Non-TPN IV infusions such as Arterial line or Dopamine infusion.

How to use this function: The program allows up to 4 non-TPN IV infusions to be entered. For each infusion enter the name

of the infusion, hourly rate, % Dextrose and saline concentration used in the infusion

If the patient is to receive more than 4 infusions, these can be entered by combining 2 or more

infusions which are mixed in similar solutions. e.g. If Dopamine and Dobutamine are both mixed in D10W, then they can be combined together and entered as a single infusion with the hourly rate

being the sum of Dopamine plus Dobutamine hourly rates.

How the program computes this function Since the TPN 2000-N is a comprehensive nutrition, fluid and electrolyte program, it takes into account all input including enteral feeds and Non-TPN IV infusions in the final calculations. Thus

the volume of the Non-TPN IV infusions is subtracted from the total fluid goal entered, leaving the

balance amount for TPN and Intralipid volume. The Na content of Non-TPN IV infusions is similarly subtracted from the total Na goal entered. The contribution to Glucose infusion rate from the Non-

TPN IV infusions is also subtracted from the total GIR goal entered. The contribution of Non-TPN IV infusions to the total fluid, Sodium and Glucose infusion rate is displayed in the preview

window.

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Example of a Non-TPN IV infusion order computation Patient’s weight = 2.7 kg Total fluid goals = 110 ml/kg/day Total Sodium goal = 4 mEq/kg/day GIR goal = 6 mg/kg/minute Patient is to receive an arterial line infusion of half Normal saline at 1 cc/hour and a Dopamine infusion mixed in D10W at 1.5 cc/hour. The two infusions provide a total of 22 ml/kg/day of fluid, 0.7mEq/kg/day of Sodium and a GIR of 0.9mg/kg/min. Hence the volume of TPN + lipids is adjusted by the program to 88 ml/kg/day (110 minus 22)

Sodium content of TPN is adjusted to 3.3 mEq/kg/day (4 minus 0.7), and Dextrose in TPN is adjusted to 9% to provide a GIR of 5.1 mg/kg/min (6 minus 0.9).

CYCLING When to use the Cycling function Cycling of the total TPN volume over less than 24 hours is often used for patients who are on long

term TPN or those who are transitioning to home TPN. Cycling is usually done over 12 to 20 hours to allow a period of time free from TPN infusion.

How to use this function Enter the number of hours that TPN is to be cycled in the appropriate box. The program

automatically generates cycling infusion rates which include starting TPN at a lower rate for the

first hour, increasing to full rate and then decreasing to a lower rate during the last. The gradual increase and decrease in the infusion rates at the beginning and end of the TPN infusion are done

in order to prevent sudden hyperglycemia on initiating TPN with a high rate and prevent sudden hypoglycemia on abruptly stopping TPN at the end of the infusion.

Example of a TPN order cycled over 18 hours

(Note: Cycling orders are displayed on the ‘PRINT PAGE’)

Start TPN infusion at 7 cc/hour for the first hour Increase the infusion rate to 14 cc/hour for the next 16 hours Decrease the infusion rate to 7 cc/hour for the last hour.

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AMPHOTERICIN-B When to use Amphotericin-B function Use this function ONLY for patients who need to receive Amphotericin-B infusion and TPN but only

have a SINGLE IV access.

How to use this function

Enter the Amphotericin-B dose in mg/kg/day, and duration of Amphotericin-B infusion in hours in the appropriate boxes.

How the program computes this function

The program computes the volume and % of Dextrose solution for Amphotericin-B infusion to

match the Glucose infusion rate from the TPN. This ensures that the GIR does not fluctuate when TPN is discontinued and Amphotericin-B is being infused.

Amphotericin infusion is administered over the duration selected, while TPN and IL infusion is

compressed to be delivered over the remaining hours. The total fluid intake from TPN and Amphotericin-B infusion is kept constant at the value selected as the total fluid goal in ml/kg/day.

Example of an Amphotericin-B order

Infuse TPN at 9 cc/hour for 20 hours Infuse Intralipids at 2 cc/hour for 20 hours Infuse 4.5 mg of Amphotericin-B over remaining 4 hours at 9 ml hour) (Prepare Amphotericin-B infusion: Add 4.5 mg of Amphotericin-B to 36 ml of Dextrose 12%)

Print Page

Print page provides the following functions Generates two identical copies of TPN orders; a 'CHART COPY' and a 'PHARMACY COPY’, each containing the following information:

1. Patient's demographic data. 2. Type of venous access (central or peripheral).

3. TPN additives 4. Infusion rates for Dextrose-Amino acid solution and Intralipids

5. Current laboratory values (if entered on the 'TPN Entry' sheet) and Laboratory orders to be sent the next day (if this option is selected in the customization menu)

6. Nutritional data regarding percentage of calories from proteins, carbohydrates and

lipids, Non-protein calorie to Nitrogen ratio, calcium phosphorus ratio and osmolality.

7. Distribution of fluids, calories, sodium and glucose infusion rate from each source (TPN, enteral feeds and non-TPN IV infusions).

8. Special alerts for high Potassium infusion rate (shows up only if Potassium infusion

rate exceeds set limits)

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How to use the Print page

After completing all entries on ‘TPN Entry’ page, click on P r in to u t to go to the "Print" page.

Check each order on the ‘Print Page’ before printing to make certain that it meets the plans and

goals set for the patient and then click P rin t T P N O rde r

A message box opens up requiring the user to confirm information regarding patient data and TPN

orders as a final check before printing the TPN order. PLEASE READ ALL INFORMATION IN THIS BOX, ESPECIALLY THE PATIENT'S NAME, MEDICAL RECORD NUMBER AND MAJOR COMPONENTS OF THE TPN ORDER TO ENSURE THAT THIS IS THE CORRECT ORDER BELONGING TO THE CORRECT PATIENT.

Note: TPN order cannot be printed unless all ‘critical errors’ are corrected. Attempting to print will result in an error message:

"Critical errors / omissions! TPN orders cannot be printed until corrected" A list of all critical errors will be displayed in the message box. Click ‘OK’ to return to the ‘TPN

Entry’ page and modify order to correct the errors.

Stamp the printed sheet with patient’s Addressograph and sign in the appropriate box before

sending the orders to the Pharmacy.

Drips Page

Drips page provides the following functions 1. Enables ordering of NON-TPN IV infusions (e.g. arterial line, Dopamine, etc). A printout of

the infusion order with detailed calculations and instructions on how to mix the infusions is

printed. 2. Preview window displays the hourly infusion rates, Sodium intake and Glucose infusion

rates of all infusions, including total hourly rate and total daily fluid input (ml/kg/day). 3. Dose ranges for all the commonly used drug infusions are provided for easy reference.

Maximum and minimum limits are set to prevent errors in dosing.

4. Drug doses, volume of infusion and type of solution in which the infusion is prepared can be changed as needed.

5. Alert message to: "Infuse through central line ONLY" is displayed if concentrations of Dextrose, Calcium or Potassium exceed the limits set for peripheral lines .

6. Electrolytes in Maintenance fluids can be ordered either as mEq/kg/day or mEq/liter.

How to use the "Drips" page

1. Enter patient demographic data on the ‘TPN Entry’ page before using the ‘Drips Page’. 2. Enter patient’s current weight in the appropriate box on the ‘Drip Page’.

3. Select an infusion by clicking on the check box on the left side of each infusion name

(The selected infusion name is highlighted in red). 4. Enter additional information for the selected infusion (blue colored boxes) such as

dose, dextrose and electrolyte concentration, volume of infusion to be prepared etc. Note: A help box opens up for each entry to assist with helpful information.

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5. The hourly rates for all infusions is calculated by the program based on doses

selected (except rates for arterial and umbilical lines needs to be entered by the user)

6. Check the ‘Preview Window’ (shown above) in the upper section of the page to review information on all selected drips regarding rates, glucose and sodium intake

and total fluid input per day.

7. Check for Alerts/Errors in the suggestion box in the ‘Preview Window’ 8. Check and Print orders: Scroll to the bottom of the page to confirm that all orders

are appropriate.

9. To print the infusions click on P r in t D r i p O r d e r s button on the top of the page. Stamp

the printed sheet with patient’s Addressograph and sign in the appropriate box.

10. To use VLBW Fluid Protocol, click on VLBW fluid Protocol

button. A message box

displays IV fluid information for Arterial line and Umbilical lines (rates, sodium and dextrose concentration). The total fluid goal, Na intake and Glucose infusion rate is

also displayed. Clicking ‘Yes’ selects the displayed drips which are then entered on the drips page. Any of the drips automatically entered by the program can then be

modified to specifications.

Note: The specific drips selected depend upon the birthweight and are based on a customized protocol entered on the ‘Customize Page’ by an Authorized person.

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Nutritional Consult Page

Nutritional Consult Page provides the following functions 1. Imports TPN information from ‘TPN Entry’ and includes it on the consult page.

2. Provides entry for 'Assessment', 'Recommendations' and other nutritional information entered by the nutritionist.

3. Places a Message on the ‘TPN Entry’ sheet alerting the physician to new recommendations

made by the nutritionist. 4. Recommendations which have been noted by the physician are marked as ‘Read’. 5. Displays graphic weight chart 6. Generates a Printout of Consult

How to use the functions on Nutritional Consult Page

1. This page is used by the Nutritionist to generate a consult for each patient. Most of the

data on the consult sheet, such as current TPN and feeding orders, laboratory values, is automatically imported from the TPN data entry sheet eliminating the need for re-

entry. 2. Enter all relevant data including the 'Assessment' and 'Recommendation' sections of

the sheet. Enter serial weights and corresponding date under the ‘Assessment’ section to

generate a Weight chart.

3. After completing all sections, click on Fla g Re com m e nda tions

This places a message on the TPN data entry page alerting the physician to check the updated

recommendations. 4. After checking the recommendations the physician clicks on:

"Please click here ---> if you have checked these recommendations". This

actions places the following message on the Consult page; " Consult and recommendations noted by physician / NNP" indicating that the consult has been noted.

5. To print a copy of the ‘Consult Page’ click on P r i n t C o n su l t

Nutritional Consult Page provides the following functions 7. Imports TPN information from ‘TPN Entry’and includes it on the consult page.

8. Provides entry for 'Assessment', 'Recommendations' and other nutritional information entered by the nutritionist.

9. Places a Message on the ‘TPN Entry’ sheet alerting the physician to new recommendations

made by the nutritionist. 10. Recommendations which have been noted by the physician are marked as ‘Read’. 11. Displays graphic weight chart 12. Generates a Printout of Consult

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How to use the functions on Nutritional Consult Page

6. This page is used by the Nutritionist to generate a consult for each patient. Most of the

data on the consult sheet, such as current TPN and feeding orders, laboratory values, is

automatically imported from the TPN data entry sheet eliminating the need for re-entry.

7. Enter all relevant data including the 'Assessment' and 'Recommendation' sections of the sheet. Enter serial weights and corresponding date under the ‘Assessment’ section to

generate a Weight chart.

8. After completing all sections, click on Fla g Re com m e nda tions

This places a message on the TPN data entry page alerting the physician to check the updated

recommendations.

9. After checking the recommendations the physician clicks on: "Please click here ---> if you have checked these recommendations". This

actions places the following message on the Consult page; " Consult and recommendations noted by physician / NNP" indicating that the consult has been noted.

10. To print a copy of the ‘Consult Page’ click on P r i n t C o n su l t

Additional feature Caloric goals entered under 'Recommendations' are graphically displayed next to the actual caloric

intake on the ‘TPN Entry’ sheet. This provides a quick visual indicator comparing the amount of calories received vs. the actual caloric goal recommended.

Note

Entries can by placed by the Nutritionist only in the boxes meant for input. Entries outside these areas is restricted and attempting to enter data in these areas will result in an error messages

stating:

"The cell or chart you are trying to change is protected and therefore read only"

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Formulas Page

The Enteral Formulas page provides the following functions

1. Displays the intake of each additive from Parenteral source, Enteral source and

Combined intake from both sources. 2. Displays the selected enteral formula and its constituents.

3. Displays other formulas available for selection with information on constituents and special features.

4. Provides ability to concentrate or dilute the selected formula to specific caloric density.

5. Provides for supplementation of formula with fats, carbohydrates, sodium and potassium.

How to use "Formulas" page In most cases the contents on this page are for information only and no user intervention is

needed.

Additional functions include: a) To concentrate or dilute a formula from its standard concentration. e.g. to

Concentrate Enfamil 20 to 24 calories/ounce formula. Click on the down or up arrows as shown below till you get a desired value of caloric density displayed in the adjoining box or enter the

desired caloric density directly in the box

To change caloric density Click up /down arrow or enter value in box

The program updates all the constituents of the formula to reflect the new caloric density. (Note the background color of boxes change to indicate that formula has been modified)

including a new highlighted message indicating that the caloric density of formula has been changed.)

b) To add supplemental to enteral formulas.

Scroll down to the bottom of the page to the section shown below

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Enter the TOTAL DAILY amount of fat, Carbohydrate, Sodium or Potassium supplement. The program updates the respective amount of fat or carbohydrate and the caloric value under the

'Enteral intake' column to reflect the addition from the supplements. (Note the background color of

the enteral supplement changes to indicate that the value has been modified by added supplement)

You can select between Safflower oil / MCT oil / Microlipid (for fats) and Polycose powder / Polycose liquid / Moducal (for carbohydrates) by clicking on the name and selecting from the drop

down list (click on the down arrow on the right)

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Calcium Phosphorus Page

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The Cal-Phos page provides the following functions

1. Displays Calcium: Phosphorus solubility tables for different concentrations of Trophamine with or without Cysteine (40 mg/gm of Trophamine)

2. Determines Calcium: Phosphorus solubility based on the values displayed in the tables and alerts user to Calcium Phosphorus precipitation. Provides suggestions to correct Calcium:

Phosphorus precipitation.

How to use the functions on Cal-Phos Page No entry or calculation is necessary on the user's part for the Calcium Phosphorus page.

The program automatically determines the calcium phosphorus solubility and alerts the user to possible precipitation. The tables displayed on this page are provided ONLY as a reference to show

how the program calculates the solubility. Error messages and suggestions on how to prevent

precipitation are displayed on the ‘TPN Entry’ page.

The values provided in the tables are for REFERENCE ONLY AND CANNOT BE CONSIDERED AS ABSOLUTE GUARANTEE AGAINGST precipitation. Each pharmacy needs to check and approve these tables prior to use. Each TPN bottle needs to be checked for precipitation before and during administration.

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Customization Page

The Customization page provides the following functions

1. Customization of minimum and maximum limits for TPN additives. The program will

display an ERROR message if these limits are exceeded and prevent the user from overriding the set limits.

2. Customization of standard concentrations (amount per ml) of each additive stock

solution used in compounding TPN. The program uses these concentrations to calculate the volume of each additive.

3. Customization of laboratory monitoring recommended during TPN administration as per policies in existence at each institution.

How to use the functions on Customization Page

1. The entries on this page are password protected and can be MODIFIED ONLY BY AN AUTHORIZED SYSTEM ADMINISTRATOR according to each hospital’s policies and procedures

2. Unprotect the page for changes: Click on ‘Tools’ on the menu bar. Click ‘Protection’, ‘Unprotect sheet’, enter password

in the box and click ‘OK’. Make the necessary changes as needed making sure that these

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are according to institutional policies. Pharmacists, dieticians and physicians should discuss

and agree upon the customized values to be entered on this page. 3. Protect the Customization page after changes are made:

Click ‘Tools’, ‘Protection’, ‘Protect Sheet’, enter password, reconfirm password and Click ‘OK’. Save and close the file.

Saving and Closing the program

1) To save a new patient’s TPN: Click “File”, “Save As”, and in the File Name box, replace “Blank TPN” with patient’s name (Last, First) and click “Save”

2) To save an existing patient’s TPN: Click “File”, “Save”. (No need to enter patients name as file already carries the patient’s name)

After saving click “File”, “Close” (or) “Exit”, to close the file and exit the program.

(NOTE: For New Patient ALWAYS use SAVE AS

For existing patient ALWAYS use SAVE)

Customer Support

• Contact your Nutritionist / Pharmacist with Nutritional or Calculation questions

or problems. IT department for server questions

OR

• For Technical Support Contact Marvin Medi-Soft, LLC at www.tpn2000.com or email

to admin@tpn2000.com

• Phone: 480-588-2190, Toll Free: 1 (877) TPN-EASY