Development of a computational recommendation system for parenteral nutrition prescription: An algorithm study

Abstract

There is a drive in some countries to increase the use of mul/-chamber bags as an alterna/ve to compounded parenteral support for pa/ents with chronic intes/nal failure in order to preserve asep/c pharmacy capacity. If a required regimen is that of an mul/- chamber bag plus one intravenous intravenous fluid product, then the poten/al combina/ons of available products can exceed 3000. Method A computer-based selec/on algorithm known as ‘PNMatch’ was developed, which u/lises a ‘kNearest Neighbour’ strategy for matching. Following comple/on of the computa/onal design for the algorithm, a staged tes/ng and development process was undertaken, evalua/ng the algorithm against clinician prescribing. A matching assessment was then undertaken against exis/ng prescrip/ons. Results Algorithm func/onality was assessed through 20 parenteral nutri/on formula/on requests, all of which were successfully processed. Prescrip/on selec/on demonstrated a 90% exact match rate, with one unmatched case and one non-improved match. The mean /me for prescrip/on selec/on using PNMatch was 116 seconds. Mul/-chamber mul/-chamber bags s requests were then evaluated. Most prescrip/ons matched closely with the exis/ng formula/ons, achieving a Cohen’s kappa value of 0.8. Further analysis of 44 formula/on requests showed successful product selec/on for 43 requests. The mean difference in volume was -75.3 ml, and for potassium, it was -4.9 mmol. Conclusion This is the first demonstra/on of the successful development and tes/ng of a computerbased selec/on algorithm for the prescrip/on of mul/-chamber bags-based regime for pa/ents with chronic intes/nal failure. This has the poten/al to improve efficiency and reduced variability in parenteral support prescribing