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Additive Assistant Calculator Screen
(screen # 313)

This screen is used to automatically select/recommend additives in order to achieve specific electrolyte levels.  The results will indicate any differences between the desired totals and the calculated totals, and give you the opportunity to confirm before making any changes to the TPN order.

ADDITIVES AND QUANTITIES RECOMMENDED BY THIS CALCULATOR SHOULD BE REVIEWED/APPROVED BY AN AUTHORIZED INDIVIDUAL PRIOR TO USE IN A PATIENT ORDER.

See also: TPN Order Screen, TPN Order Template Screen

The screen data entry form fields and specific instructions are described below.

Screen Data Entry Fields:

Required Data Entry Field

Select Desired
Electrolytes

Description: Selects the anions and cations and the sequence in which they are to be displayed/printed
Type: Checkbox Selection List
Default Value: Basic Electrolytes.
Specifics:  Select the anions and cations in the sequence that you would like them to appear.  The sequence that a user selects the checkbox for each ion indicates the sequence that the ion is to appear in the anion/cation list.  That is, the first ion checkbox selected will be the first ion that appears in the list, the second ion checkbox selected will be the second ion that appears in the list, etc.  As each checkbox is selected, the corresponding ion name appears in the Additive Assistant Calculator ion list.  Selecting the “Clear All” link clears all ion checkboxes and remove all ions from the list of ions.  When the electrolyte totals are displayed or printed the selected electrolytes will appear first, followed by any remaining electrolyte totals.

Required Data Entry Field

Desired
Electrolyte Totals

Description: Electrolyte Totals Desired
Type: Electrolyte amount, with per-units, and importance setting
Default Value: None
Specifics:  Enter the desired electrolyte totals, select the units, and set the relative Importance as desired.
Note: To use the CL- and AC- electrolyte amount fields, the Importance should be set higher than the CL:AC ratio.

Optional Data Entry Field

CL:AC [ratio]

Description: CL:AC Ratio Desired
Type: Numeric, Ratio
Default Value: None
Specifics:  Enter the desired CL:AC ratio.  The CL:AC ratio is the amount of CL in mEq units to the amount of AC in mEq units; if alternate units are used they will be converted to mEq for the CL:AC ratio calculation.
To minimize CL-, enter 0:1.  To minimize AC-, enter 1:0.
To enter an equal distribution of CL- and AC- (i.e., 50%/50%), enter 1:1
Note: You must also set the importance of the CL:AC ratio higher than the CL- and AC- electrolyte values for the ratio to be considered in the calculation.
Example :  "2:1"

Optional Data Entry Field

Aluminum Content
Minimization

Description: Aluminum content importance
Type: Multiple Choice
Default Value: Medium Importance
Specifics:  Select the relative importance of minimizing the aluminum content. 

Optional Data Entry Field

Cost Minimization

Description: Cost minimization importance
Type: Multiple Choice
Default Value: Medium Importance
Specifics:  Select the relative importance of cost in calculating the solution. 

Required Data Entry Field

Calculator Algorithm

Description: Calculator Algorithm to Use
Type: Drop-down Selection List
Default Value: Automatic
Specifics:  Select the calculator algorithm to use. The available algorithms are:
  • Automatic (All)
  • All less Simulated Annealing (Random)
  • Linear Equation Solver
  • Pharmacist Expert Method
  • Simulated Annealing (both deterministic and random)
  • Additive Priority Method

Optional Settings

Solution Priority List

Description: Solution Selection Preferences
Type: Link
Default Value: None
Specifics:  The Solution Priority List is used when there are more than one additive solution that could be selected that will satisfy the desired order. Clicking on the Solution Priority List link brings up a list of additive solutions that can be arranged in the desired order totals. The Solution Priority List only shows additive solutions that are applicable to the particular patient type.

TPN Order Calculator Results and Options:

For TPN orders, after the desired anion/cation order information has been entered, click the Calculate button.

No changes will be made to the TPN order at this time; the results will be displayed and then you will have the opportunity to update the TPN order with the recommended results.

The results of the last calculation are defined as "This Result".  The result can be temporarily stored as the "Best Result" by clicking the Save This Result as Best button.  Only one “Best Result” solution can be temporarily saved.  When saved as a "Best Result" solution, the Calculator can then be used to search for even better results without losing the best one found so far.  The user will then have the option to choose between the last saved "Best Result" and the most recently presented "This Result" anytime prior to leaving this screen.

If a result is determined to be satisfactory, the result can be accepted and utilized in the associated Patient TPN Order by clicking the Accept This Proposed Order button.

To assist the user in their decision making process, the calculator results include a spreadsheet summary section and a detailed results section. 

Results Summary Spreadsheet: Displays in a tabular format the anion and cation totals, chloride to acetate ratio, osmolarity, number of components and estimate cost of the order for the following points: starting amount (values when the Additive Assistant Calculator was first entered), desired (values most recently entered as target values in the Additive Assistant Calculator, This Result, and “Best” Result (if any).

Results Detail Information: Displays in a tabular format the additive solutions that would compose the order for both This Result and Best Result (if any) options including solution name, order dose, and volume required.  Also presents the anion and cation totals, chloride to acetate ratio, osmolarity, and estimate cost of the order for the This Result, and “Best” Result (if any) options.

The results of the last calculation are shown in the "This Result" column of both sections.  To see a detailed anion/cation contribution breakdown for a result by contributing solution, click on the associated "This Result" or "Best Result" column title in the "Results Detail Information" section.  If the result is satisfactory, select the desired Additive Order Units and click the respective Accept This Proposed Order button.

The Additive Order Units selection can be used to define the method in which the contributing electrolyte solutions will be displayed in the main TPN Order Entry Screen.  If the solution order units are to be displayed in milliliters, the “mLs” radio button should be selected.  If the solution order units are to be displayed in default units (e.g., mEq, mmol), including any per units selected in the Desired Electrolyte Totals section of the screen, the “Default Units for Each Additive” radio button should be selected.

Note – The calculator input importance level settings can be used as a tool to ensure the calculator assists in providing a preferred solution.  If two items are both assigned the same importance factor, both items will be treated equally by the calculator, resulting in potentially an unexpected response.  For example, if an exact solution cannot be found, decreasing the sodium importance factor might allow for Potassium Phosphate to be used as a solution in place of Sodium Phosphate.  Or, instead of decreasing the level of sodium to find a solution, it may instead increase a suggested level of acetate.  If you are not happy with suggested solutions, try changing importance factors to obtain a solution you would like to see.

Note – The per units selected in the Desired Electrolyte Totals section of the screen, if any, is also used to display the Nutritional Summary per units in the main TPN Order Entry Screen (Screen 310).  The Accept This Proposed Order button must be selected at least one time for these units to appear.

Note – Under certain conditions, the calculation process can take a long time (several minutes).  The calculation time can be decreased by configuring the additive solutions as follows:

  • Reduce the number of additives that can are eligible for automatic selection to a minimum.
  • Reduce the allowed Patient Types for each additive to a minimum.

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