# Evaluating a Clinical Decision Support System for Optimizing Total Parenteral Nutrition in Adult Oncology Patients

## TL;DR

A clinical decision support system helps optimize total parenteral nutrition for adult oncology patients by identifying suitable pre-made formulas and supplementing missing nutrients.

## Contribution

This study evaluates a CDSS for optimizing TPN prescriptions in oncology patients, revealing discrepancies in micronutrient coverage.

## Key findings

- CDSS-optimized TPN fully covered macronutrient needs but required supplementation for most micronutrients.
- Phosphorus was the only micronutrient fully met by the ready-to-use TPN formula.
- Electrolytes like sodium, potassium, and calcium were significantly underprovided in standard TPN solutions.

## Abstract

Background/Objectives: In oncology patients, total parenteral nutrition (TPN) prescriptions are complex and depend on individual nutritional and clinical status. Prescriptions for TPN solutions often result in over- or under-dosing of specific nutrients, due to the large number of ingredients and formulation-related constraints. Clinical support decision systems (CDSSs) may assist clinicians in complex decision-making processes. The aim of this study was to quantify discrepancies between CDSS TPN prescriptions and ready-to-use PN formulation compositions administered in routine clinical practice. Methods: In this cross-sectional study, 40 hospitalized adult oncology patients who were prescribed TPN were recruited. CDSS data was used to calculate individual nutritional needs (i.e., fluids, micro-/macronutrients, and electrolytes) and utilized to identify the closest available standardized ready-to-use TPN formula corresponding to those needs. The algorithm created by the use of the CDSS was based on evidence-based equations from ASPEN. We compared the CDSS-calculated nutritional needs with the ready-to-use TPN formula and identified nutrients that had to be added to the TPN solution bag. Results: The daily needs of all macronutrients were fully covered by the ready-to-use TPN, while actual intake of micronutrients, except for phosphorus (P), was insufficient and had to be supplemented in the TPN bag (amino acids: +21.1%, p < 0.001; lipids: +8.4%, p = 0.023; P: +32.5% p = 0.001; Na: −30.5%, p < 0.001; K: −50.6% (p < 0.001); Ca: −51.7%, p < 0.001). Conclusions: The use of the CDSS tool could facilitate PN prescriptions by indicating the most suitable standardized commercial PN solutions to support patients’ nutritional needs and help physicians assess the patient’s additional needs.