Nutrition Support Error

This morning the RD who worked the weekend asked the RD I was working with today and I to check on a patient that she had left a nutrition support recommendation for. She had received a consult over the weekend for nutrition support. The consult was for PPN, so she calculated the appropriate rate for PPN and left a recommendation. When we looked at the chart this morning, he was receiving TPN at the rate that had been recommended for PPN!!! This was about 3500kcals for a man who is 71" 137#, so very clearly above his needs. We hunted down the nurse to talk to her about it, and she told us that his blood sugar had been well over 500 since the rate was increased on his TPN. We were able to track down the MD, and got her permission to write an order to change the rate ASAP to something more appropriate for his needs. Nutrition support was recommended because the patient hadn't been eating for quite a few days. We were really worried about the possibility of refeeding syndrome. The first thing we worried about was his Mg and P levels, and tried to check his labs, but the Mg and P levels hadn't been checked for the day. We are planning to follow up with the pt first thing tomorrow and make sure his blood sugars have normalized and that his Mg and P levels are alright.
It was amazing that a rate like this could have actually been started on a patient. Not only did the recommendation clearly state that it was for PPN, but pharmacy is supposed to be checking behind the MD whenever they order TPN or PPN. The nurse also didn't track down the MD right away when she saw his blood sugar levels up in the 500s. Luckily we caught it within a day of it being started, but it obviously could have been pretty disastrous for this patient. One of the RDs has been trying to start a nutrition support team at the hospital, and I think she just got another example of why it is really important to have a lot of eyes checking and double checking on nutrition support.