Safety & Efficiency Improvements in Parenteral Nutrition

Safety & Efficiency Improvements in Parenteral Nutrition

Recent Tips of the Week have discussed issues around managing technology. Quite a bit of this has concerned the use of electronic health records (EHRs) to promote better decision-making and reduce the likelihood of errsdw ors. There are technological improvements across nearly every facet of practice, and many of these also have the prospects of improving safety, or at the very least improving efficiency so as to reduce costs. In the hospital, many patients cannot be fed by mouth due to any of a number of medical, physical, or logistical reasons and thus must be placed on parenteral nutrition. Given the very specific dietary needs of patients, along with the possibility of food-drug interactions and issues around stability of intravenously delivered compounds, precision, accuracy and efficiency are paramount in the prescribing, delivery, and administration of parenteral nutrition to patients.

Curtis describes emerging technology in parenteral nutrition compounding, with much-need advances in bar-coded medication preparation systems and in EHR-to-compounder interfaces.1 These technology advances have: reduced the need for order transcription through use of CPOE; introduced a “photo-finish” check for hand-added ingredients using barcode-assisted medication preparation (BCMP) systems; introduced quality assurance checks with refractometry and laboratory; and have incorporated new techniques to detect micro-organisms and endotoxin. Curtis explains how the use of contemporary parenteral admixture systems have reduced errors, for example, from 2-3% down to approximately 0.2%, or 2 in every 1,000 nutrition bags and how use of BCMP has not only reduced errors but also turnaround times from order to preparation and delivery of nutrition bags from 52 minutes down to 34 minutes. Refractometry employs the use of a refractive index (RI, ratio of velocity of light to air to the velocity of light in the substance) so as to verify concentrations. There have also been advanced in sterility detection, with the newer technology enabling this process to be quicker yet more accurate.

Curtis reminds the reader that there is still more research to be done and still more technological breakthroughs on the horizon. Pharmacy managers will need to stay abreast of these as well as employ effective decision-making that will include trust of the vendor and their after-purchase support, discern the right time to purchase technology with capital budgets given that there will always be new technological advances (like the decision on when to buy a new mobile phone and which upgrade/model to purchase) and that these decisions have to be made in context of various budgetary incremental improvements or decrements from upper administration of the hospital and in keeping with the hospital’s broader goals and mission as it relates to quality assurance initiatives.

Additional information about Managing Medication Use Processing Supporting Technologies and Automation can be found in Pharmacy Management: Essentials for All Practice Settings, 5e. If you or your institution subscribes to AccessPharmacy, use or create your MyAccess Profile to sign-in to Pharmacy Management: Essentials for All Practice Settings, 5e. If your institution does not provide access, ask your medical librarian about subscribing.

1Curtis C. Technology in parenteral nutrition compounding. Nutr Clin Pract. 2018;33:796-802.