Background The preparation of paediatric parenteral nutrition (PPN) is subject to a great deal of variability in clinical practise. Standardization in the process is indispensable to ensure stability and improve patient safety. The pharmacist plays an essential role in the proper preparation of all-in-one PPN, and in interventions to avoid problems associated with instability.
Purpose The 2008 Spanish consensus on the preparation of parenteral nutrient mixtures established a minimum lipid percentage of 1.5%. The aim of this study was to detect PPN prescriptions with a lipid percentage below 1.5%, considered the safe limit for lipid emulsion stability in ternary mixtures.
Materials and Methods Observational retrospective descriptive study of PPN requirements in a tertiary level hospital. It was conducted between September 2011 and June 2012. Prescriptions in which the lipid composition of the PPN was less than 1.5% of the mixture were reviewed. In all cases, the intervention involved having the pharmacist contact the prescribing physician. Proposed alternatives to preserve the stability were: a) increase the proportion of lipid; b) exclude lipids from the mixture; or c) decrease the mixture volume.
Results A total of 107 interventions were made during this period. 100% of the physicians contacted accepted the intervention. In 81.3% of cases they agreed to increase the weight of lipids by an average of 1 g; the median was 0.8 g. The 18.7% remaining cases chose to exclude lipids from the mixture during the first few days, and add lipids gradually thereafter. In these cases the initial average of lipids was 1.1 g, and the median 0.8 g. In no case was the total volume changed.
Conclusions The results support the role of the pharmacist in the proper management of paediatric PNN, and in ensuring the quality and safety of the mixture. The results also support the importance of pharmacist-physician collaboration.
No conflict of interest.
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