Background and importance Parenteral nutrition is needed for preterm and ill babies in the neonatal intensive care unit (NICU), neonatal medicine unit (NMU) and paediatric intensive care unit (PICU). In our centre, each parenteral nutrition (PN) prescription is analysed by a pharmacist before compounding. In cases of prescribing errors, the pharmacist alerts the prescribers and performs a pharmaceutical intervention (PI).
Aim and objectives We have implemented a tool for the routine reporting of PI for sterile preparation units for PN, ‘ACTIP Nutrition’. This tool is an adaptation of the French Society of Clinical Pharmacy (SFPC) hospital pharmacists’ reporting tool for recording the PI. This work allowed us to validate the tool ACTIP Nutrition and evaluate the rate of avoidable errors with an electronic prescriptions software package.
Material and methods The study was carried out in the sterile preparation unit over 2 months. The prescriptions of PN were analysed according to the usual practice. Each detected PI was scored according to ‘ACTIP Nutrition’ and recorded in the national database of PI, ACTIP.
Results A total of 627 prescriptions were analysed of which 37% required pharmaceutical intervention. 17% of the orders required two or more interventions. The intervention rate was 41% for the NICU, 31% for the NMU and 18% for the PICU. The top three interventions performed were underdosing of vitamins and trace elements (n=71), instability due to phosphate (n=45), and wrong choice of ingredient in the mix (n=27). The majority of PIs performed were dosage adjustments (56%).
Electronic prescribing software could eliminate 15% of errors (eg, transcription), and if a thesaurus or guidelines are incorporated into the software then an additional 14% of errors could be avoided. The PI rate would drop from 37% to 23%.
Conclusion and relevance Pharmaceutical analysis is a crucial process for limiting errors in paediatric parenteral nutrition. The ACTIP Nutrition tool allows PIs to be entered into the ACTIP database and harmonises practice between pharmacists to promote the role of the pharmacist. The American Society for Parenteral and Enteral Nutrition (ASPEN) recommends electronic prescriptions to secure patient care. In our centre, almost 30% of errors were avoidable with the use of prescriptions software. Unfortunately, our study took place over a short period (2 months) and the PIs refused were not collected.
Conflict of interest No conflict of interest
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