a. A TPN order must be written for each 24 hours of patient feeding.

b. Orders must be received in the pharmacy no later than 4:00 P.M. daily. Late orders will be placed in a lower priority than other medication orders. If the next TPN bottle is not available when needed on the Nursing Unit, a Dextrose 10% Solution will need to be hung until the order is available.

c. The Pharmacy will provide each TPN fluid in a sequential number series with the number appearing on the label of the container. Before hanging a TPN the nurse is to compare the label data to the most recent physician’s order. Discrepancies or questions are to be directed to the Pharmacy before the TPN is hung.

d. All TPN solutions will be sent to the nursing unit at 7:00 P.M. and are to be hung at 8:00 P.M. This includes the initial fluid order.

e. No additional ingredients are to be added without first contacting the Pharmacy.

f. Normal expiration dating for a TPN fluid is 36 hours from the time of preparation.

g. TPN orders are not considered to qualify for a "STAT," "NOW," or "EMERGENCY" designation. A Dextrose 5% Solution is to be hung when a new subclavian line is put into place until a chest X-ray verifies the placement of the catheter in the vena cava. When positioning has been verified, hang a Dextrose 10% Solution until 8:00 P.M. when the first unit of TPN fluid is delivered.

h. No TPN order will be prepared if the order is incomplete or questionable until all information is clarified by a physician.

i. The Pharmacy is to communicate to the nurse any changes in orders that the physician may make directly with the Pharmacist. The nurse should make an annotation to the original TPN order and the physician is to initial the changes as soon as possible.