Optimization of pharmaceutical analysis for nominative parenteral nutrition (NPN) bags prescriptions in neonatal and pediatric intensive care unit

Introduction

This study is based on IGAS recommendations and DGOS instruction (20/03/2015) to risk management related to parenteral nutrition (PN) activity in neonatal and pediatric intensive care unit. Its recommend to use first industrial PN (IPN) bags with AMM, then standardized PN (SPN) bags and, at last, nominative PN bags (NPN) prepared in Pharmacy Department (PD).

The aim of this study is first to retrospectively analyze problems encountered during daily prescriptions analysis (non-conformities, instabilities, phosphocalcic precipitation) and then build a tool to compare NPN prescription with available SPN and IPN to propose substitutions.

Materials and methods

A retrospective analysis of pharmaceutical interventions (PI) recorded in 2017 was conducted. From January to July 2017 for weekend NPN prescriptions, all non-conformities, mixture instabilities or phosphocalcic precipitation risks were recorded.
The tool to compare NPNs prescriptions with SPNs and IPNs was developed on Excel®. The data of 4 binary SPN formulation (a standard formula may associated with one of the 3 formulas with variable electrolyte composition) as well as 4 IPN bags referenced in the hospital, were collected.

Results and discussion

On 2000 analyzed prescriptions, 154 PIs were registered (8%). These PIs mainly concern mixture instability (82%), a deviation from the recommendations (6.5%), and a phosphocalcic precipitation risk (4.5%). For the weekend prescriptions (n = 101), 43 non-conformities were noted (65% concerned the recommendations, 55% mixture instability and 9% precipitation risk). After input of total supplies and volume which are prescribed, the tool propose a combination of 2 formulas of SPN or IPN. A calculation define difference of each contribution between initial prescription and the proposals, this with a weighting to help the medical decision.

Conclusions

Considering identified risks on prescriptions during the weekend and national recommendations, pediatricians are very interested by this tool. Tests are in progress on care unit and at PD, in order to make adjustments and optimize its use before sending NPN prescription to PD.