Background According to the American Society of Health System Pharmacists (ASHP) and the American Society of Parenteral and Enteral Nutrition (ASPEN), the pharmacist is responsible for proper preparation of parenteral nutrition (PN), for control during the process and for the final product.
The European Medicines Agency (EMA) and the United States Pharmacopoeia (USP) postulate that 100% of PN must be prepared with a gravimetric error <5% for larger volumes of 100 mL.
Quality control of the elaboration process includes components and gravimetric tests, which are used to identify areas with potential errors and therefore areas that could be improved.
Purpose To evaluate the quality control established in PN elaboration for 6 months, to determine the number and types of errors, and to identify opportunities for improvement.
Material and methods A data collection notebook was designed for prior checking, which describes the type of error and the number of times it occurs. The process begins with preparation of the components required for each PN by the nursing assistant. Then the pharmacist checks the occurrence of the components, and records any discrepancies found. Finally, the nurse makes a second check before compounding the PN.
Regarding control of the finished product, PN solutions were weighed checking that the gravimetric error did not exceed 3%. In the case of this limit being exceeded, possible causes were investigated and the preparation was repeated.
Results 1238 PN were performed (1127 adults, 111 paediatric). 109 errors were found in 62 PN (5% of the total), with an average of 0.1 errors per PN, distributed as shown in table 1.
Regarding the gravimetric test, 9 PN (0.7%) had to be prepared again because the gravimetric error exceed the 3% limit.
Conclusion Quality control of the PN has proven effective in detecting errors, noting that the second check can correct errors unnoticed in the first checkup. It is highly important that the staff involved are trained in advance to avoid errors during the process.
No conflict of interest.
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