Parenteral Nutrition Electrolyte and Mineral Product Shortage Considerations

Plogsted, Steve; Adams, Stephen; Allen, Karen; Breen, Heather B.; Cober, M. Petrea; Greaves, June; Mogensen, Kris M.; Ralph, Amy; Ward, Ceressa T.; Ybarra, Joe; Holcombe, Beverly

doi:10.1177/0884533615621550

Cited by 11 publications

(23 citation statements)

References 9 publications

(25 reference statements)

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“…The American Society for Parenteral and Enteral Nutrition (ASPEN) issued recommendations regarding the management of parenteral nutrition product shortages during the peak of the 2010–2012 shortage [17]. The ASPEN recommended to use specific pediatric or neonatal products only for these patient groups [18]. If these are on shortage, however, parenteral nutrition should be saved for the patients in the NICU who need it most, such as very preterm or ELBW infants, or sick neonates with enteral obstruction, necrotizing enterocolitis, or after surgery.…”

Section: Discussionmentioning

confidence: 99%

Prescription Drug Shortages: Impact on Neonatal Intensive Care

et al. 2018

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Background: Prescription drug shortages have increased significantly during the past two decades and also impact drugs used in critical care and pediatrics. Objectives: To analyze drug shortages affecting medications used in neonatal intensive care units (NICUs). Methods: Drug shortage data for the top 100 NICU drugs were retrieved from the University of Utah Drug Information Service from 2001 to 2016. Data were analyzed focusing on drug class, formulation, reason for shortage, and shortage duration. Results: Seventy-four of the top 100 NICU drugs were impacted by 227 shortages (10.3% of total shortages). Twenty-eight (12.3%) shortages were unresolved as of December 2016. Resolved shortages had a median duration of 8.8 months (interquartile range 3.6–21.3), and generic drugs were involved in 175 (87.9%). An alternative agent was available for 171 (85.8%) drugs but 120 (70.2%) of alternatives were also affected by shortages. Parenteral drugs were involved in 172 (86.4%) shortages, with longer durations than nonparenteral drugs (9.9 vs. 6.4 months, p = 0.022). The most common shortage reason was manufacturing problems (32.2%). Conclusions: Drug shortages affected many agents used in NICUs, which can have quality and safety implications for patient care, especially in extremely low birth weight infants. Neonatologists must be aware of current shortages and implement mitigation strategies to optimize patient care.

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Section: Discussionmentioning

confidence: 99%

Prescription Drug Shortages: Impact on Neonatal Intensive Care

et al. 2018

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“…ASPEN provides strategies for managing shortages of individual PN components, including amino acids, lipid injectable emulsion, electrolytes and minerals, trace elements, vitamins, and L‐cysteine. Each shortage management consideration provides recommendations specific to the individual PN component as well as general strategies for managing shortages of PN components . The 2014 ASPEN Parenteral Nutrition Safety Consensus Recommendations include guidance for every step of the PN use process to improve the safety of PN therapy during shortages of PN components.…”

Section: Strategies and Resources For Managing Drug Shortagesmentioning

confidence: 99%

Drug Shortages: Effect on Parenteral Nutrition Therapy

2018

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Drug shortages continue to be a threat to the health and welfare of numerous patients in the United States. For patients who depend on parenteral nutrition (PN) for survival, these shortages pose an even greater threat. Almost 75% of active drug shortages are sterile injectables, which includes PN components. Providing PN therapy is particularly challenging for clinicians because this is a complex medication and may contain 40 or more individual ingredients, of which multiple components may simultaneously be in limited supply. The availability of PN components must be considered during every step of the PN use process from ordering the PN prescription to administering this therapy to a patient. Alterations to a standardized process can lead to medication errors that can adversely affect patient outcomes and consume healthcare resources. (Nutr Clin Pract. 2018;33:53-61)

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“…Calcium gluconate is preferred over calcium chloride in PN. The original calcium phosphate solubility studies were completed with calcium gluconate and should not be extrapolated to calcium chloride 20 . The amount of elemental calcium provided by each product is significantly different, further demonstrating that these products are not equivalent substitutes.…”

Section: Solution Basicsmentioning

confidence: 99%

“…If necessary, many vitamins are available in their individual forms, except biotin, pantothenic acid, riboflavin, and vitamins A, D, and E. During times of multivitamin shortages, the American Society for Parenteral and Enteral Nutrition recommends that IV vitamin preparations be given 3 times weekly. Chewable vitamin supplements twice daily can be used for patients with IF on days when multivitamins are not infused 27 . The admixture of multivitamins to PN is unstable, requiring that patients receiving HPN add vitamins to their PN just prior to infusion.…”

Section: Solution Basicsmentioning

confidence: 99%

Overview of Home Parenteral Nutrition: An Update

et al. 2017

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The trend in modern medicine is to transition care from the hospital to home or other nonacute settings as soon as possible. Increasingly, nutrition support professionals are being asked to help facilitate discharge and/or manage patients who require prolonged intravenous fluid and/or nutrition after having been stabilized during a hospitalization. This updated tutorial reviews many of the concepts and challenges that must be considered for successful care that helps to focus on the patients and their quality of life.

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Parenteral Nutrition Electrolyte and Mineral Product Shortage Considerations

Cited by 11 publications

References 9 publications

Prescription Drug Shortages: Impact on Neonatal Intensive Care

Prescription Drug Shortages: Impact on Neonatal Intensive Care

Drug Shortages: Effect on Parenteral Nutrition Therapy

Overview of Home Parenteral Nutrition: An Update

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