Sommer Isabelle, Palmero David, Fischer Fumeaux Céline Julie, Bonnabry Pascal, Bouchoud Lucie, Sadeghipour Farshid
Service of Pharmacy, Lausanne University Hospital, Lausanne, Switzerland.
Center for Research and Innovation in Clinical Pharmaceutical Sciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
Ther Clin Risk Manag. 2021 May 28;17:497-506. doi: 10.2147/TCRM.S280938. eCollection 2021.
There are variable practices in the management of the parenteral nutrition (PN) process in hospitals having a neonatal intensive care unit (NICU). In our hospital, PN is prepared partially on the neonatal ward by nurses but also at the central pharmacy by trained pharmacy technicians. A previous study showed a concentration non-conformity of 34% of on-ward PN preparations potentially resulting in under- or overfeeding of the patients.
The objectives were to perform preliminary risk analyses (PRA) in preparation for our hospital's transition to universal central pharmacy PN compounding.
A working group including pharmacists, neonatologists, nurses, and pharmacy technicians performed two PRA. The risks of 9 management steps of the PN process were identified, evaluated, and quoted. A comparison of the number of risks and their criticality index (CI) was conducted.
A total of 36 and 39 risks were identified for PN preparation in the NICU and the pharmacy, respectively. For the NICU, ten risks (28%) had an "acceptable" CI, 15 risks (42%) were "under control" and eleven (31%) were defined as "non-acceptable". For the pharmacy, 14 risks (36%) had an "acceptable" CI, 19 risks (49%) were "under control" and six (15%) were defined as "non-acceptable". Risks directly related to the preparation process, including the steps preparation hood, PN preparation and analytical quality control, represented a cumulated CI of 145 for eleven NICU-risks vs 108 for twelve pharmacy risks (-26%). The implementation of immediate improvement measures, eg, an electronic prescription form, reduces the total CI by 5.7% and 2.2% for the NICU and the pharmacy, respectively.
This PRA highlighted the safety differences between PN preparation in the NICU vs the pharmacy at our institution, and facilitated our moving forward with a process change that should improve the care of our neonatal patients. Nevertheless, long-term improvement measures have to be implemented to further reduce risks related to the PN management process.
在设有新生儿重症监护病房（NICU）的医院中，肠外营养（PN）过程的管理方式各不相同。在我们医院，PN部分由新生儿病房的护士配制，但也由经过培训的药剂师在中心药房配制。先前的一项研究表明，病房内PN制剂有34%的浓度不符合规定，这可能导致患者喂养不足或过度喂养。
目的是进行初步风险分析（PRA），为我院向中心药房统一配制PN的转变做准备。
一个由药剂师、新生儿科医生、护士和药剂技术员组成的工作组进行了两次PRA。确定、评估并列举了PN过程9个管理步骤的风险。对风险数量及其临界指数（CI）进行了比较。
NICU和药房PN配制分别共识别出36项和39项风险。对于NICU，10项风险（28%）的CI为“可接受”，15项风险（42%）“可控”，11项（31%）被定义为“不可接受”。对于药房，14项风险（36%）的CI为“可接受”，19项风险（49%）“可控”，6项（15%）被定义为“不可接受”。与配制过程直接相关的风险，包括配制罩、PN配制和分析质量控制步骤，11项NICU风险的累积CI为145，而12项药房风险的累积CI为108（-26%）。实施即时改进措施，如电子处方表格，NICU和药房的总CI分别降低了5.7%和2.2%。
该PRA突出了我院NICU与药房PN配制之间的安全性差异，并推动我们朝着改进新生儿患者护理的流程变革迈进。然而，必须实施长期改进措施，以进一步降低与PN管理过程相关的风险。
