Nutrition of the newborn - spneonatologia.pt · ¾ TPN (content) can be customized or standard ¾ All these choices are made Ù Ùby the pharmacy where there is the logistics and

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)