Parenteral Nutrition Process Management for Newborn and Preterm Infants - A Preliminary Risk Analysis

Isabelle Sommer; David Palmero; Céline Julie Fischer Fumeaux; Pascal Bonnabry; Lucie Bouchoud; Farshid Sadeghipour

doi:10.2147/TCRM.S280938

Parenteral Nutrition Process Management for Newborn and Preterm Infants - A Preliminary Risk Analysis

Ther Clin Risk Manag. 2021 May 28:17:497-506. doi: 10.2147/TCRM.S280938. eCollection 2021.

Authors

Isabelle Sommer^{1

2

3

4}, David Palmero¹, Céline Julie Fischer Fumeaux⁵, Pascal Bonnabry^{3

4

6}, Lucie Bouchoud⁶, Farshid Sadeghipour^{1

2

3

4}

Affiliations

¹ Service of Pharmacy, Lausanne University Hospital, Lausanne, Switzerland.
² Center for Research and Innovation in Clinical Pharmaceutical Sciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
³ School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland.
⁴ Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, Geneva, Switzerland.
⁵ Clinic of Neonatology, Department Woman Mother Child, Lausanne University Hospital, Lausanne, Switzerland.
⁶ Service of Pharmacy,Geneva University Hospital, Geneva, Switzerland.

Abstract

Background: There are variable practices in the management of the parenteral nutrition (PN) process in hospitals having a neonatal intensive care unit (NICU). In our hospital, PN is prepared partially on the neonatal ward by nurses but also at the central pharmacy by trained pharmacy technicians. A previous study showed a concentration non-conformity of 34% of on-ward PN preparations potentially resulting in under- or overfeeding of the patients.

Objective: The objectives were to perform preliminary risk analyses (PRA) in preparation for our hospital's transition to universal central pharmacy PN compounding.

Methods: A working group including pharmacists, neonatologists, nurses, and pharmacy technicians performed two PRA. The risks of 9 management steps of the PN process were identified, evaluated, and quoted. A comparison of the number of risks and their criticality index (CI) was conducted.

Results: A total of 36 and 39 risks were identified for PN preparation in the NICU and the pharmacy, respectively. For the NICU, ten risks (28%) had an "acceptable" CI, 15 risks (42%) were "under control" and eleven (31%) were defined as "non-acceptable". For the pharmacy, 14 risks (36%) had an "acceptable" CI, 19 risks (49%) were "under control" and six (15%) were defined as "non-acceptable". Risks directly related to the preparation process, including the steps preparation hood, PN preparation and analytical quality control, represented a cumulated CI of 145 for eleven NICU-risks vs 108 for twelve pharmacy risks (-26%). The implementation of immediate improvement measures, eg, an electronic prescription form, reduces the total CI by 5.7% and 2.2% for the NICU and the pharmacy, respectively.

Conclusion: This PRA highlighted the safety differences between PN preparation in the NICU vs the pharmacy at our institution, and facilitated our moving forward with a process change that should improve the care of our neonatal patients. Nevertheless, long-term improvement measures have to be implemented to further reduce risks related to the PN management process.

Keywords: drug compounding; neonatology; parenteral nutrition; preterm infants; risk assessment; standardization.