Nutrition of the newborn Rita Oliveira Hospital Pharmacist
Nutrition of the newborn
Rita Oliveira Hospital Pharmacist
Quality Management in Healthcare ...
Top Practices Evaluation / Follow-up
Commitment to Patient and Team
Transparency of information provided
1. Concern for Quantity of TPN
Proper amount
Caloric supply adequate
Balance: HC / protein / lipid
Na, K, Ca, Mg, Cl, P
Bone mineralization
Vitamins and Trace Elements
2. Concern for Quality of TPN
Double Validation of prescription
Physical and chemical stability
Double validation of preparation
Contamination Danger
Microbiological Control
3. Concern about costs
Cost of preparation
Measuring the TOTAL costs
Cost of Error
(prescription and preparation)
Cost of contamination and infection
Cost of waste
Best practices??
Standardization
Prescription
Pharmaceutical Validation
Pre Preparation + Preparation + Labels (Double validation)
Preparation of TPN (with 2nd element to verify)
Validation of Preparation
The A solution is administered by infusion line and connects itself to the solution B with "Y“ connection
TPN
Solution A
Glucose Amino Acids Electrolyte Vitamins and Trace elements
Solution B
Lipids
TPN (content) can be customized or standard
All these choices are made by the pharmacy where there is the logistics and
"Know how" to prepare and manipulate
The advantage of the custom is to allow prescribers → easy to establish the
formulation according to the nutritional needs of infants or children
(adaptability)
The advantage of standardized is the availability (independent of time and
availability of pharmacy)
In both situations: ↓ ↓ metabolic complications and nursing manipulation
(infection)
To have a central unit for preparation of TPN → REQUIREMENTS
(facilities, human resources, equipment, defined procedures, process control
to avoid error, microbiological control and close collaboration with clinical
services)
Should be carried out in aseptic environment
There is decreased risk of error and contamination and maximize the use
of products used in the preparations maximizing the process economically
BUT .... the risk has not disappeared ..
The WHO states that 1 in every 3,000 shares of aseptic processing system are
contaminated
Even handling in a closed system, TPN prepared in the pharmacy
Microbiological contamination can arise from poor use of aseptic technique;
by contamination of the packaging, bags or syringes and bad hygiene
procedures for personnel involved in the preparation
Possible limitations ...
1. Compliance with best practices - Aseptic technique?
2. Prescription errors and/or in Preparation
3. Contamination and Infection Risk
4. Physical and Chemical Stability and Validity of the final
solution
Compliance with best practices - Aseptic technique??
Compliance with best practices - Aseptic technique?
The aim is sterile and pyrogen-free mixture
The human accounts for 40% to 80% contamination (skin fragments, hair,
saliva droplets, cosmetics, released tissue particles ..)
Particulate emissions by makeup: Eye shadow 82 million, 600 million blush,
lipstick 1 billion
Cough - 5000 gotículas/1000 microorganisms
Talk - 100 palavras/250 gotículas/25 microorganisms
Leticia Boechat, 2002
Compliance with best practices - Aseptic technique??
The TPN preparation services centralized in hospital pharmacies have emerged in
the U.S., UK and France (80)
UK → CIVAS (Centralised Intravenous Additive Service)
EUA → CAPS ( Centralised Additive Pharmacy Service)
Reduction of error by pharmaceutical validation
Decreased risk of microbiological contamination
Maximize the use of pharmaceuticals
Economic profitability of the process
Prescription errors and/or Preparation
"The medication error is any preventable event that may
lead to inappropriate use of medication, or impair the
wearer, while the medication is under the control of
the health professional, the user or consumer." National Coordinating Council for Reporting and Preventing Medication Errors (E.U.A.)
Prescription errors and/or Preparation
9% error in sterile preparations In TPN the % error was 37% (manual) and 22% (partly automated)