Background Clinical pharmacist (CP) services to hospitalised patients are highly recommended, especially in vulnerable populations such as neonates. Neonates are in need of prompt nutrition support but total parenteral nutrition (TPN) practices remain unsatisfactory due to a lack of knowledge of neonatal nutritional needs. The CP plays a crucial role in all steps of TPN: prescribing review, compounding and administering instructions. However, there is insufficient evidence related to the role of the CP in the neonatal intensive care unit (NICU) setting, and most of the literature is either outdated or focuses on lack of standardisation of practices, and the role of CP as prescriber in the NICU. Few (and none in our country) have focused on the role of the CP in all TPN related processes and the impact on decreasing the potential errors and fatal events.
Purpose To evaluate the impact of involving the CP in TPN order review and preparation in the NICU on the potential errors related to 2 in 1 (dextrose/amino acids) and lipid prescription orders.
Material and methods A 6 month prospective analysis was conducted in NICU where TPN order set forms that were elaborated by the CP were filled by neonatologists and sent on a daily basis to the CP for review, calculations, issuing of labels and instructions for compounding and administration. Any noted error or discrepancy in the order was communicated to the neonatologist for prompt amendment.
Results 209 2 in 1 and 149 lipid prescription orders were analysed. 57.5% of 2 in 1 and 11.5% of lipid prescriptions contained errors in dosing, infusion rate and volume, missing components, wrong venous access or high risk of precipitation. The most common 2 in 1 order errors prevented by the CP involved: amino acid dose (14.6%), followed by total infusion volume (13.2%), rate of infusion (13.2%), heparin dose (13.2%), missing component (12.5%), precipitation of calcium and phosphorus risk (12.1%), dextrose dose (9.2%), venous access not mentioned (8.4%), venous access (central vs peripheral) (1.8%), trace element dose (1.1%) and electrolytes dose (0.7%). The most common lipid order errors prevented by the CP involved: rate of infusion (44.5%), followed by total infusion volume (37%), lipid dose(11.1%), lipid soluble vitamin dose (3.7%) and missing component (3.7%).
Conclusion This study shows the impact of including the CP in TPN processes by highlighting the potential errors of prescription/preparation and fatal events that he/she can prevent, thus achieving optimal neonatal nutritional needs and contributing to patient safety. Further studies could be conducted to assess the financial impact of CP driven TPN error prevention as well as other roles of the CP in the NICU setting, which remains a neglected area.
No conflict of interest
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