Background Since the March 2015 directive publication of the country’s health department, parenteral nutrition (PN) must be produced by hospital pharmacists, under pharmaceutical responsibility. How to manage closing periods of the hospital pharmacy unit (HPU) to manufacture individualised formulation of paediatric PN (IFPN) for newborns.
Purpose Summarise the state of management of HPU closure for IFPN through a survey of hospitals in the country in 2017.
Material and methods A survey with oriented questions according to answers was developed. This form was sent by email to the hospital pharmacist.
After general questions (Healthcare Establishment (HE) type: General Hospital Centre (GHC) or University Hospital Centre (UHC), maternity level (classed 1 to 3 in our country)), the first part approaches alternative solutions in case of no production during the HPU closing period. Then, the second part, for IFPN production, which answers different questions concerning formulation validation, production and controls.
Results Nineteen received responses were studied. For HE type: 17 UHC (89.5%) and two GHC (10.5%), all had a maternity (whose 95% with neonatal intensive care unit, level 3 (n=18)). Twelve of 17 pharmacists (65%) report no IFPN during the closing period. A major alternative solution is IFPN, which wereproduced before the closure period (e.g. on Friday). While 16% (n=2) of HE reported using only IFPN, 83.3% (n=10) use IFPN and standardised PN (SPN) and 25% (n=3) associated IFPN, SPN, and industrial PN (with or without supplementation).
For other HE (35%, n=7) with PN activity on the weekend, 57.1% (n=4) produces IFPN at HPU and 42.9% (n=3) in the paediatric care unit. Only IFPN which were produced at HPU are formulations checked by a pharmacist. Then, for controls, everybody declared a double visual control during production, 71% realised analytics assays (mainly Na and K), 40% performed microbiologic assay and 60% (n=4) labelling check and mirage. Pharmaceutical liberation is reported on 80%.
Conclusion These results based on statements remain to be analysed cautiously but the trend is no production of IFPN on the weekend. In case of preparations, controls on final product allows the provision of a quality product for newborns. Compliance with the directive remains difficult, perhaps a consensus around SPN with paediatric physicians will make it possible to avoid PN production activity outside the opening period of HPU.
References and/or Acknowledgements Pharmacists who had completed survey.
No conflict of interest
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