Standardized Competencies for Parenteral Nutrition Order Review and Parenteral Nutrition Preparation, Including Compounding

Boullata, Joseph I.; Holcombe, Beverly; Sacks, Gordon S.; Gervasio, Jane M.; Adams, Stephen; Christensen, Michael L.; Durfee, Sharon M.; Ayers, Phil; Marshall, Neil; Guenter, Peggi

doi:10.1177/0884533616653833

Cited by 34 publications

(53 citation statements)

References 26 publications

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“…Recommendation 12D: Prescribers should receive education and demonstrate competency to manage PN, a complex and high‐risk medication, to reduce the risk of errors and therapy‐related complications 1 , 2 , 16 , 17 . While there is limited literature, education in PN prescribing has been associated with decreases in overall PN prescription errors and overfeeding 18 .…”

Section: Question 12: What Strategies Should Healthcare Organizationsmentioning

confidence: 99%

When Is Parenteral Nutrition Appropriate?

Worthington

Balint

Bechtold

et al. 2017

J Parenter Enteral Nutr

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176

202

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Parenteral nutrition (PN) represents one of the most notable achievements of modern medicine, serving as a therapeutic modality for all age groups across the healthcare continuum. PN offers a life-sustaining option when intestinal failure prevents adequate oral or enteral nutrition. However, providing nutrients by vein is an expensive form of nutrition support, and serious adverse events can occur. In an effort to provide clinical guidance regarding PN therapy, the Board of Directors of the American Society for Parenteral and Enteral Nutrition (ASPEN) convened a task force to develop consensus recommendations regarding appropriate PN use. The recommendations contained in this document aim to delineate appropriate PN use and promote clinical benefits while minimizing the risks associated with the therapy. These consensus recommendations build on previous ASPEN clinical guidelines and consensus recommendations for PN safety. They are intended to guide evidence-based decisions regarding appropriate PN use for organizations and individual professionals, including physicians, nurses, dietitians, pharmacists, and other clinicians involved in providing PN. They not only support decisions related to initiating and managing PN but also serve as a guide for developing quality monitoring tools for PN and for identifying areas for further research. Finally, the recommendations contained within the document are also designed to inform decisions made by additional stakeholders, such as policy makers and third-party payers, by providing current perspectives regarding the use of PN in a variety of healthcare settings. (JPEN J Parenter Enteral Nutr. 2017;41:324-377) The etiology-based nutrition diagnoses in adults in clinical practice settings are as follows: Starvation-related malnutrition: Chronic starvation without inflammation (eg, anorexia nervosa). Chronic disease-related malnutrition: Inflammation is chronicand of mild to moderate degree (eg, organ failure, pancreatic cancer, rheumatoid arthritis, sarcopenic obesity). Acute disease or injury-related malnutrition:Inflammation is acute and of severe degree (eg, major infection burns, trauma, closed head injury). 2,3Malnutrition, pediatric: An imbalance between nutrient requirement and intake, resulting in cumulative deficits of energy, protein, or micronutrients that may negatively affect growth, development, and other relevant outcomes. It is recommended that growth charts based on a standard deviation z score system be used to track and assess nutrition status in children. 4,5Nutritionally-at-risk: Consider the individual nutritionally-atrisk if any of the following is present. Nutritionally-At-Risk Adult Summary of RecommendationsThese consensus recommendations are designed to identify best practices, guide day-to-day clinical decisions, reduce variations in practice, and enhance patient safety. They are not intended to supersede the judgment of the healthcare professional based on the circumstances of the individual patient.

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Section: Question 12: What Strategies Should Healthcare Organizationsmentioning

confidence: 99%

When Is Parenteral Nutrition Appropriate?

Worthington

Balint

Bechtold

et al. 2017

J Parenter Enteral Nutr

Self Cite

176

202

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“…Computerized physician order entry (CPOE) systems are designed to reduce prescribing errors (16, 19, 20). In addition, clinical pharmacists play an important role in reducing MEs in pediatric patients (21–24). …”

Section: Introductionmentioning

confidence: 99%

Incidence and Severity of Prescribing Errors in Parenteral Nutrition for Pediatric Inpatients at a Neonatal and Pediatric Intensive Care Unit

et al. 2017

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ObjectivesPediatric inpatients are particularly vulnerable to medication errors (MEs), especially in highly individualized preparations like parenteral nutrition (PN). Aside from prescribing via a computerized physician order entry system (CPOE), we evaluated the effect of cross-checking by a clinical pharmacist to prevent harm from PN order errors in a neonatal and pediatric intensive care unit (NICU/PICU).MethodsThe incidence of prescribing errors in PN in a tertiary level NICU/PICU was surveyed prospectively between March 2012 and July 2013 (n = 3,012 orders). A pharmacist cross-checked all PN orders prior to preparation. Errors were assigned to seven different error-type categories. Three independent experts from different academic tertiary level NICUs judged the severity of each error according to the National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP) Index (categories A–I).ResultsThe error rate was 3.9% for all 3,012 orders (118 prescribing errors in 111 orders). 77 (6.0%, 1,277 orders) errors occurred in the category concentration range, all concerning a relative overdose of calcium gluconate for peripheral infusion. The majority of all events (60%) were assigned to categories C and D (without major harmful consequences) while 28% could not be assigned due to missing majority decision. Potential harmful consequences requiring interventions (category E) could have occurred in 12% of assessments.ConclusionNext to systematic application of clinical guidelines and prescribing via CPOE, order review by a clinical pharmacist is still required to effectively reduce MEs and thus to prevent minor and major adverse drug events with the aim to enhance medication safety.

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“…In fact, ≈20%–30% of clinically relevant PN‐related medication errors involve ILE . Preparation tasks include compounding admixtures or activating commercial MCBs with additives, then labeling and dispensing them appropriately . Administration includes verification procedures followed by setting the appropriate rate and duration of infusion with administration through in‐line filtration …”

Section: Ile In the Pn‐use Processmentioning

confidence: 99%

“…Commercial MCB products require less manipulation to activate, and then require a limited number of additives. However, addition of an ILE to a commercial 2‐chamber PN product still requires close evaluation by the pharmacist for compatibility and stability . Survey data suggest that many organizations in the United States may be compounding small numbers of PN with limited experience or appreciation of the compatibility and stability limitations, potentially placing patients at risk of receiving incompatible or unstable PN admixtures .…”

Section: Ile Preparationmentioning

confidence: 99%

“…It is recommended that a pharmacist review all ordered PN admixtures, whether they will be compounded or further prepared from a commercial MCB product . It is worth noting that at this meeting it was discussed that preparation of PN should only be performed by or under the direct supervision of an expert pharmacist (see also statement 40).…”

Section: Ile Preparationmentioning

confidence: 99%

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Use of Intravenous Lipid Emulsions With Parenteral Nutrition: Practical Handling Aspects

Boullata

Berlana

Piętka³

et al. 2020

J Parenter Enteral Nutr

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A number of topics important to the handling of intravenous lipid emulsions (ILEs) were discussed at the international summit. ILE handling includes the preparation and the administration steps in the typical use of parenteral nutrition (PN). The discussion and consensus statements addressed several issues, including standardization of the PN process, use of commercially available multi‐chamber PN or compounded PN bags, the supervision by a pharmacist with expertise, limiting ILE repackaging, and infusion duration.

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Standardized Competencies for Parenteral Nutrition Order Review and Parenteral Nutrition Preparation, Including Compounding

Cited by 34 publications

References 26 publications

When Is Parenteral Nutrition Appropriate?

When Is Parenteral Nutrition Appropriate?

Incidence and Severity of Prescribing Errors in Parenteral Nutrition for Pediatric Inpatients at a Neonatal and Pediatric Intensive Care Unit

Use of Intravenous Lipid Emulsions With Parenteral Nutrition: Practical Handling Aspects

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