Production’s transfer of lipids ‘syringes from neonatal reanimation unit to the pharmacy: towards standardization of parenteral nutrition’s practices

V. Larbre, M. Wasiak, P. Chennell, L. Delaborde, B. Bœuf, M. Jouannet-Romaszko, V. Sautou Hospital-University Center of Clermont-Ferrand, 63000 Clermont-Ferrand, France

Context

DGOS/DGS directive of 20th march 2015 stipulates the suppression of all parenteral nutrition (PN) production in pediatric units, and its management by hospital pharmacies. In our teaching hospital, the measure concerns the production of mixtures of lipids and vitamins conditioned in syringes (LS), for neonatology units.

Objectives

To standardize medical practices and develop hospital preparations (HP) of LS to enable PN for each child from the birth event outside the pharmacy’s opening hours.

Material and methods

A multidisciplinary working group (pediatricians, pharmacists, nurses, and pharmacy technicians) was created, and a questionnaire was designed to identify practices, necessary resources controls and logistic constraints. A literature review enabled to select a single formula desired by doctors and to determine the LS stability.

Results

The caregivers’ expectations were evaluated, a standardized LS formula was established (lipids (80%), hydro (6%) and fat-soluble (10%) vitamins, trace elements (4%)), and a new LS production’s circuit initiated. The LS are prepared at the pharmacy from a single bag divided into syringes; stability is short (4 days). The quality controls implemented are: raw materials verification (including batch number and expiry date), visual inspection of the content and container, label check, pH and osmolality measurements and sterility assay.

Discussion and conclusion

The transfer of LS production led us to elaborate a fixed formula: practices were standardized, permanent availability of LS and their quality enhanced. The quick preemption of LS due to the instability of certain components makes liberatory microbiologic control of this HP impossible, but process controls are realized. This new organization enables a nutritional coverage of prematures from their birth, with respect of latest official recommendations.

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