Multidisciplinary Workgroup for the Improvement of preparation practices for parenteral nutrition

Parenteral nutrition injections (NP) are prepared by nurses in neonatalogy’s department. The geographic isolation of our hospital doesn’t allow us to outsource this activity. The hospital pharmacy will only be equipped for such preparation in 2016 (new hospital). Following Chambery’s incidents, a multidisciplinary workgroup led by the pharmacy department has been formed to improve practices.

Method

The workgroup is composed by the management team, the Pharmacy, Neonatology, Hygiene, Biochemistry and Biomedical departments. The Evaluation of the circuit and the aseptic preparation of NP was performed: sterility test, Media Fill test, determination of endotoxins and surface sampling.

Results

The circuit is not secure: computerized prescription on Excel, no pharmaceutical validation, no specific procedure nor quality assurance documentation. Over three days, 33 solutions and 12 lipid syringes were manufactured. The microbiological results show that 50% of solutions (S), 33% of syringes lipid tests (L), 7% of Media Fill’s solution are contaminated. Identified germs are: Kocuria spp (S), mold (S), Micrococcus luteus (B, L), Bacillus cereus (S, L), Microbacterium spp (L), Staphylococcus spp (S, L). The endotoxin doses are compliant. 25% of gelose-agar are contaminated.

Conclusion

A prescription software will be deployed and an isolator installed near the neonatology department. The pharmacy department will be in charge of the outsourced activity: NP pharmaceutical analysis, preparation, validation. The physicochemical and microbiological controls will be systemized. Intermediate measures have been taken until the isolator can be used: Re-evaluate the possibility to prescribe commercialized standard solution on a daily basis, audit preparation-administration practices and document specific procedures for the preparation of NP infusion filters referencing 0.22 and 1.2 microns.