GoodNews Volume 6 No. 1

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JOINT COMMISSION PATIENT SAFETY GOALS:
How Do They Impact PN Compounding? Recent Industry Discussions Clarify
the Intention of NPSG 3B
The Joint Commission’s National Patient Safety Goal (NPSG) 3B states, “Standardize and limit the number of drug concentrations available in the organization.”¹ In 2006, the following question was posed for comment to the Joint Commission, “Does NSPG 3b require that parenteral nutrition (PN) solutions be standardized in their component concentrations, including electrolytes?” The Joint Commission’s initial response was controversial – “PNs are technically drugs; therefore, this safety goal applies and hospitals should have standardized concentrations for these products.” Since its release, there has been much debate among the pharmacy profession and its professional organizations over the comment and its inference.

Discussion sessions on the issue of PN standardization and its implications took place at the American Society for Health-System Pharmacists meeting in December 2006. More recently, the leadership of The American Society of Parenteral and Enteral Nutrition (ASPEN) has been involved in discussions with the Joint Commission on issues pertaining to the safety of PN procedures. These discussions led the Joint Commission to review and revise their view of parenteral nutrition (PN) as it relates to NSPG 3B.

The Joint Commission’s revised response to the above question, coupled with a newly posted question and answer, clearly delineates how PNs should be treated under this safety goal, standardized PN formulations are not currently required under NPSG 3B.” The Commission goes on to state, “…the intent of NPSG requirement 3B is to reduce variation and that a standardized process for managing PN is essential to meet this intent.” This standardized process would, “…most importantly include standardized ordering formats, labeling, terminology, etc.”

This response, posted on the Joint Commission Web site as FAQs for the 2007 NPSG, explains that the organization has entered into discussion with ASPEN and states, “Organizations are encouraged to review the current literature on this topic and to evaluate the pros and cons of using standardized PN formulations…”²

PN is an individualized therapy based on patient-specific parameters not unlike other drugs (i.e., chemotherapy, some antibiotics, cardiac drugs, etc) dosed on a “per kg” basis. The Joint Commission acknowledges in the same document that, “for drugs…which are dosed based on patient’s weight or body surface area, standardized concentrations of intermittently infused drugs is not practical, is wasteful, and may have a higher potential for harm…”²

Standardization of process is not the same as standardization of solutions. For the best clinical practice, pharmacists must evaluate not only the available drugs and compounds, but the technology to support them and the strict process controls that ensure med error reduction.

Professionals must take all available resources into account in determining the best means to achieve clinical outcomes while addressing patient safety and regulatory compliance.

The Joint Commission, 2006 Critical Access Hospital and Hospital National Patient Safety Goals, 3B
www.jointcommission.org/PatientSafety/NationalPatientSafetyGoals/. Frequently Asked Questions about the 2007 NPSGs.