Management of parenteral nutrition process for newborn and preterm infants – results of a preliminary risk analysis

Isabelle Sommer, Farshid Sadeghipour Pharmacy, CHUV, Lausanne; Section of pharmaceutical sciences (EPGL), University of Lausanne, University of Geneva; Switzerland

Backgound

There are variable practices of managing parenteral nutrition (PN) process in hospitals having a neonatal service. In our hospital, PN is prepared partially on the neonatal ward by nurses and at the central pharmacy by trained pharmacy technicians. The PN preparation is known to be one of the most critical steps within its management. Hence, its centralization at the pharmacy is in project.

Objectives

In prevision of this centralization, a preliminary risk analysis (PRA) was performed. The objectives were to identify and evaluate the risks associated to the management of PN considering the fact that it is performed on these two separate preparation sites. The necessity of an action plan before centralizing was discussed and defined.

Method

A working group including pharmacists, neonatologists, nurses and pharmacy technicians performed two PRA. The different risks of 9 management steps of PN process (Medical prescription, Transcription, Primary material, Preparation hood, PN preparation, Dosage analysis, Administration, Documentation, Quality control) were individually evaluated and quoted (gravity (1-5) x probability (1-5) = Criticality (1-25)) for the two preparation sites. A comparison of the number of risks and their criticality (“acceptable” (1-6), “under control” (7-15), “unacceptable” (16-25)) was conducted.

Results

A total of 38 risks were identified for the neonatal unit and 39 for the pharmacy. For the neonatology, 14 risks had an “acceptable” criticality, 18 risks were “under control” and six were defined as “unacceptable”. For the pharmacy, 14 risks had an “acceptable” criticality, 21 risks were “under control” and four were defined as “unacceptable”. Three “unacceptable” risks were related to the PN preparation on the ward versus one at the pharmacy with a criticality of 16. Only one of the three “unacceptable” risks on the neonatal ward was reducible to an “under control” risk by training the nurses.

Conclusion

The PRA highlighted problems when comparing the PN preparation on the ward to its preparation at the pharmacy. It brought out the advantages of a centralized PN production, which helps to secure the management of the PN process and increases their quality for neonatal patients.