Comparison of two types of TPN prescription methods in preterm neonates

Skouroliakou, Maria; Koutri, Katerina; Stathopoulou, Maria G.; Vourvouhaki, Ekaterini; Giannopoulou, Ifigenia; Gounaris, Antonios

doi:10.1007/s11096-009-9281-4

Cited by 23 publications

(18 citation statements)

References 26 publications

(32 reference statements)

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“…Another example is electronic prescription: Electronic prescription would reduce the RPN of many failure modes listed during the AMDEC (Table 4). Several studies show better nutritional management of patients in care units in which there is electronic prescription [4,22]. In addition, the use of pediatric-specific software for prescribing reduces the risk of errors and helps secure the circuit [23].…”

Section: Discussionmentioning

confidence: 99%

Controlling Risks in the Compounding Process of Individually Formulated Parenteral Nutrition: Use of the FMECA Method (Failure modes, effects, and Criticality Analysis)

Royer

Libessart

Dubaele

et al. 2020

Pharmaceutical Technology in Hospital Pharmacy

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AbstractParenteral nutrition (PN) in the neonatal intensive care unit (NICU) involves a succession of risky processes. The objective was to identify and prioritize the risks associated with PN in order to improve the quality of the pathway. A failure modes, effects, and criticality analysis (FMECA) was used to identify potential PN pathway failure modes. A multidisciplinary working group conducted a functional analysis of the processes, then listed the failure modes (FM). The FM criticality was assessed on a scale from 1 to 5 for occurrence (O), severity (S), and detection (D). The risk priority number (RPN), ranging from 1 to 125, was calculated. The FMECA identified 99 FM (prescription (n=28), preparation (n=48), and administration (n=23)). The median RPN was 12, with scores ranging from 3 to 48. 25 % of the scores had an RPN>21.75.Among them, 12 were associated with prescription FM, 5 were associated with FM related to preparation and 8 were associated with a FM linked to administration. It allowed us to prioritize areas of potential quality improvement for parenteral nutrition of the preterm infant. The results demonstrated the need for the presence of a clinical pharmacist in the NICU to ensure the quality of PN process.

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Section: Discussionmentioning

confidence: 99%

Controlling Risks in the Compounding Process of Individually Formulated Parenteral Nutrition: Use of the FMECA Method (Failure modes, effects, and Criticality Analysis)

Royer

Libessart

Dubaele

et al. 2020

Pharmaceutical Technology in Hospital Pharmacy

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show abstract

“…It is also well known that oxidative stress is related to morbidities associated with prematurity and that vitamin E can be used as an antioxidant defence of the body. 27 Vitamin E is a major free radical scavenger. Tocopherols inhibit lipid peroxidation by scavenging lipid peroxyl radicals much faster than the radicals can react with the fatty acid side chains, thus breaking the chain reaction.…”

Section: Discussionmentioning

confidence: 99%

Physicochemical stability assessment of all-in-one parenteral emulsion for neonates containing SMOFlipid

et al. 2012

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The aim of the study was to assess the stability of all-in-one (AIO) parenteral admixture used for neonates, containing SMOFlipid, an alternative to soybean, an α-tocopherol-enriched lipid emulsion. SMOFlipid, consisting of soybean oil, medium chain triglycerides, olive oil and fish oil, was introduced commercially in 2005. Stability assays consisted of the assessment of the admixture's macroscopic aspect, droplet size distribution, pH, peroxide value and α-tocopherol concentration. The admixture was stored at room temperature or at 4°C and analysed over time (0, 24 and 48 h). The SMOFlipid-containing AIO parenteral admixture was shown to be physicochemically stable. All changes were reversible, the droplet size was under the upper limit (0.5 µm) set by the US Pharmacopeia, maximum loss for vitamin E was 25% and the lipid peroxidation occurred within 24 h after preparation. In conclusion, the addition of SMOFlipid to an AIO parenteral admixture for neonates did not affect its physicochemical stability, and it was safe for administration on the first day of its preparation.

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“…Some recently published studies demonstrated the feasibility of using standardized, even commercial PN in pediatrics and neonatology, although no clear advantage has been demonstrated. [14][15][16][17][18][19] A survey from Israel conducted in 2005 showed that 18 of 25 neonatal intensive care units used commercial PN bags, whereas all others used standardized PN compounded on-site. 20 Standardized commercial PN, albeit theoretically lower in costs and workload, may be inappropriate in several clinical situations, and it forces reliance on the availability of such a product, which, as the recent drug shortage crisis has demonstrated, is not always consistent.…”

Section: Discussionmentioning

confidence: 99%

Automated Compounding of Parenteral Nutrition for Pediatric Patients: Characterization of Workload and Costs

Raimbault

Thibault

Lebel

et al. 2012

The Journal of Pediatric Pharmacology and Therapeutics

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OBJECTIVES Parenteral nutrition (PN) compounding in large hospital centers is now largely automated using volumetric pump systems. No study has examined the pharmacy workload and costs associated with this process. This study was designed to characterize these elements at our center and to identify areas for potential improvement. METHODS We retrospectively analyzed all PN orders compounded from May 19, 2007, to June 25, 2010. Patients were divided into groups according to the ward where PN was initiated. RESULTS The age and weight of patients at initiation of PN were similar throughout the study, except in neonatology, where initiation now occurs earlier in life (age 1.3 ± 2.7 days in 2010 vs. 3.4 ± 9.4 in 2007; p=0.003). An average of 894 orders per month were compounded. A total of 59% of orders were for neonatal patients. The average cost of source solutions per PN order increased from Can$23.27 in 2007 to Can$37.78 in 2010. Partially used source solutions discarded at the end of the day represented between 7.7% and 9.2% of total source solution cost. Amino acids in 3-L bags were responsible for the largest waste, with Can$953 to Can$1048 wasted monthly. CONCLUSIONS PN compounding at our center represents an important workload and increasing costs. A reduction in source solution waste, for example, by reducing the use of large source solution containers, would be beneficial.

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Comparison of two types of TPN prescription methods in preterm neonates

Abstract: The use of standardized protocols in preterm neonates resulted in more adequate provision of nutrients, weight gain and better blood count profile compared with protocols prescribed by individual physicians.

Cited by 23 publications

References 26 publications

Controlling Risks in the Compounding Process of Individually Formulated Parenteral Nutrition: Use of the FMECA Method (Failure modes, effects, and Criticality Analysis)

Controlling Risks in the Compounding Process of Individually Formulated Parenteral Nutrition: Use of the FMECA Method (Failure modes, effects, and Criticality Analysis)

Physicochemical stability assessment of all-in-one parenteral emulsion for neonates containing SMOFlipid

Automated Compounding of Parenteral Nutrition for Pediatric Patients: Characterization of Workload and Costs

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