Process Changes at Lucile Packard Children’s Hospital Result in Safer and More Efficient Nutrition Compounding

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The introduction of the Baxa automated compounder and Monterey Medical Software allows a leading children’s hospital to minimize med errors, reduce man hours and improve clinical efficacy.

With medical errors being one of the top 10 leading causes of death in this country, error reduction is a priority at most hospitals. In an effort to address this and other clinical concerns, Lucile Packard Children’s Hospital (LPCH) launched a program to update their Total Parenteral Nutrition (TPN) processes. The program’s primary objective was to develop a safer, more clinically effective TPN environment. A multi-disciplinary team formed to look at the available alternatives to meet this and other objectives, such as decreasing adverse drug events (ADEs), compliance with USP 797, minimizing infection risk and reducing compounding time.

After careful consideration, in March of 2004, the task force elected to integrate Baxa Corporation’s Exacta-Mix 2400 (EM2400) hardware and the TPN Medsoft™ Software from Monterey Medical Solutions into their TPN process. “It was evident from day one that this combination of LPCH, Baxa and Monterey Medical was a win-win-win situation,” notes task force member and LPCH Director of Pharmacy, Dr. Robert Poole. “For example, we immediately went from three technicians mixing TPN solutions 6.5 hours each per day under three sterile hoods, to one technician mixing compounds six hours per day under one sterile hood.” In addition, notes Poole, “Over the last 24 months, we have decreased ADEs by over 70%., decreased our rates of TPN-related pharmacy interventions, and reduced the number of steps in the process, with fewer incident reports.”

Intravenous nutritional therapy, or TPN, supplies essential nutrients like proteins, carbohydrates, fats, vitamins, minerals and trace elements. An intricate and error-prone process, TPN therapy for children averages 16 ingredients, nine of which can be lethal if given in excessive doses. Prior to implementing the Baxa system, LPCH relied on a macro compounder for most of its needs. LPCH upgraded to the Baxa EM2400 system because as a state-of-the-art automated closed system, it decreased the potential for human error and touch contamination and minimized the opportunity for infection.

The combination of LPCH–Baxa–Monterey Medical focused on individual patient’s needs. First used at LPCH, the TPN Medsoft Software automates the processing of physicians’ prescriptions to create easy-to-follow instructions for pharmacists, making potentially dangerous procedures more reliable and safer to implement. The software also notifies the prescriber if there are variations between the prescribed amount to be given to the patient and the amount listed in standard nutritional protocols. The Windows®-based software has a user interface that is easy to understand and implement. Its users – doctors, nurses and pharmacists – have extensive training in nutritional therapy and can learn the new software in a matter of minutes.

The EM2400 also is Windows®-based, with graphical user interfaces and touch-screen control. It uses bar code verification of source ingredients and patient prescriptions and incorporates an audit record for quality assurance and accuracy.

Dr. Poole credits the new TPN process with ensuring a much safer treatment plan for infants, as well as adults, who need TPN therapy. “It is with tools such as the EM2400 and TPN Medsoft Software that we can make TPN therapy truly safe for the first time. The TPN process we have implemented has made a huge impact on the pharmacy environment and culture at LPCH,” concluded Dr. Poole.

Internationally recognized for pediatric and obstetric care, Lucile Packard Children’s Hospital at Stanford provides a wide range of services for babies, children, adolescents and expectant mothers. LPCH pediatricians, specialty doctors, nurses and staff serve children and their families in the San Francisco Bay Area, Silicon Valley, northern California and beyond. It is recognized both for its achievements and its commitment to highly specialized care.

About Baxa Corporation

Celebrating 30 years of business in 2005, Baxa Corporation is a Denver-based manufacturer of medical devices and systems for preparing, handling, packaging, and administering liquid medications. The company manufactures and markets a wide range of healthcare products for use in hospitals, critical care units and alternate-site pharmacies. Privately held, Baxa Corporation has offices and subsidiaries in Canada, the United Kingdom; Denmark, and Germany; and distribution partners worldwide. Further information is available at

About Lucile Packard Children’s Hospital

Ranked as one of the nation's top ten pediatric hospitals by US News and World Report, Lucile Packard Children's Hospital at Stanford is a 264-bed hospital devoted to the care of children and expectant mothers. Packard Children's offers patients locally, regionally and nationally the full range of health-care programs and services -- from preventive and routine care to the diagnosis and treatment of serious illness and injury. For more information, visit

About Monterey Medical Solutions

Monterey Medical Solutions is the developer of TPN Medsoft™, a comprehensive network-based software solution that provides start-to-finish support for physician, pharmacy, nursing and nutritional support staff. TPN Medsoft facilitates the ordering, compounding, administering, and tracking of patient-specific parenteral nutrition. It provides true clinical decision support (CPOE) with selectable, standards-based nutritional protocols; institution-specific formularies cost-of-goods and printable records. Contact 800.651.8836 or visit


Marian Robinson, Vice President, Marketing

Baxa Corporation: 800.567.2292 ext. 2157 or 303.617.2157

Maggie Chamberlin Holben, APR

Absolutely Public Relations: 303.984.9801 or 303.669.3558

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Maggie Holben
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