According to a recent study published in the journal, the safe combination of parenteral nutrition is essential to prevent injury and death in patients receiving supportive therapy. Nutrition in clinical practice.1
Parenteral nutrition is an intervention used to support pediatric patients whose gastrointestinal tract is inaccessible, unusable, or cannot meet metabolic demands and growth. The preparation of compounded parenteral nutrition solutions is a complex process with a high risk of error, which can lead to serious undesirable consequences.2
The investigators conducted a study to describe current challenges in parenteral nutrition education and training, compatibility and stability of mixtures, concurrent administration of non-nutritive medications with mixtures, and specific challenges with particular populations.
“Without appropriate knowledge and understanding, as well as a vigilant need for mechanisms to ensure safety, parenteral nutrition can be fraught with danger,” the authors wrote. “As high-profile tragedies involving patient death and injury trigger a resurgence of concerns about parenteral nutrition preparation, it is critical to emphasize the importance of safe and knowledgeable sterile preparation.”
In the United States, there is a growing gap between nutrition education and training provided in various graduate medical programs. Although nutrition has a significant impact on patient outcomes, physicians and pharmacists often do not devote sufficient hours to nutrition education during their studies. This leads to knowledge gaps that lead to on-the-job nutrition training.
However, field readiness training is difficult to implement due to the time and resources required to provide training in safe and accurate techniques. The authors noted that Michigan Medicine recently established a compounding compliance team that oversaw a training program. The team has proven to be effective and could serve as a model for other institutions looking to implement something similar.
When it comes to incorporating non-nutritive medications into mixtures, clinicians must be extremely careful as this can increase the instability and incompatibility of the mixture. This is more common in pediatric and neonatal populations because venous access is usually limited.
In these situations, consideration must be given to the components of the parenteral nutritional mixture, the co-infused medication, and any excipients. The authors note that compatibility information should be evaluated. To protect the patient and ensure they receive their medications, discharge checklists have been suggested. This would include a standardized list of items to complete before discharge, such as ensuring patients understand their parenteral nutrition and necessary weekly supplies and additives.
Pediatric and neonatal populations also face various other challenges in parenteral nutritional composition. These include lower preparation doses due to patient size, the increased need for calcium and phosphorus for healthy bone development, and the small size of commercially available intravenous tubes and syringes. The authors said this may require the use of robotic technology, as it provides greater consistency and precision.
“Safe preparation of parenteral nutrition is essential to prevent injury or death in patients receiving this nutritional support therapy,” the authors concluded. “The complex nature of parenteral nutrition preparation requires that those involved in the process have the appropriate knowledge and training.”
