Monday, July 18, 2016

What Internship Looks Like VIII: So you want to order some TPN

Hello, enthusiastic Intern. I understand you want to order Total Parenteral Nutrition (TPN--basically liquid formula that can go in a vein). Let us describe the ways in which you can fail to do this properly:

Did you remember to call the pharmacy to tell them this patient needs TPN? No? Better do that now. Then you'll have time to run to the bathroom or check Facebook or something while Pharmacy freezes your access to their electronic medical record for five minutes so they can enter some necessary information.

...I see you're back. Good, do you have laboratory results for this patient? No? Are they coming today or did you forget to order any? The latter. I see. We'll just order the basic TPN, so log in. No, not that password; use the other one. The other "other one." The program is loading...okay.

What rate will it flow in the IV? Do you know the patient's Total Fluid Goal? Multiply by their most recent weight, unless they are less than 10 days old and have not regained their birth weight yet, in which case use their birth weight anyway. Good. Are they eating by mouth or tube, too? Make sure you subtract that amount from their TFG before calculating the TPN rate. Don't forget to order the right dose of heparin for their line.

Now we'll tweak the lipids and electrolytes. First, ----REDACTED----REDACTED----REDACTED----REDACTED----REDACTED----REDACTED----. Then, ----REDACTED----REDACTED----REDACTED----REDACTED----REDACTED----REDACTED----. And finally you'll want to ----REDACTED----REDACTED----REDACTED----REDACTED----REDACTED----. [This information appears to be a state secret and cannot be shared on the Internet.]

Done? No, not yet. You still have to print the prescription. Oh, I'm sorry, did you use the Resident Computer? That one doesn't print. Here, you can log on and print from my computer. What? No, that's the printer to the wrong pod. Go get it and scan and email it to the pharmacy. Oops, you just spammed the whole pharmacy list-serv; just send it to the NICU pharmacy account next time.

**RING** Pharmacy's on the phone. They say you forgot to sign and date the prescription. Please use the year "2016," not "2013." Good. Then put it in the patient's room. No, don't make the nurse come find you in the workroom--just give her the script now.

Congratulations! You have now ordered TPN (aka Total Pesky Nuisance).

An intern's tools in the NICU: clipboard, bili charts, glucose-regulation algorithm, calculator, sticky notes, phone, stapler, white out (SO MUCH WHITE OUT), water or other provisions. Seen on the left of the image is a COW (computer on wheels) for morning rounds. Now get out there and order some TPN!



  1. Michael's Docs have an easier time ordering chemo drugs...

    1. I'm sure that's true. I think they change all the order sets once you finish residency, so they make sense...


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