BEST PRACTICES IN CLINICAL NUTRITION
The October issue of Pharmacy Practice News included a Special Edition with feature articles. One of them, “Assessment Tools and Guidelines: Parenteral Nutrition Therapy” authored by Jay Mirtallo, is a good overview of the current best practice in clinical nutrition.
Included in the article is a decision tree on nutrition support that outlines when parenteral nutrition (PN) is indicated and when alternate routes should be used. In addition, there is a nice chart summarizing the ASPEN guidelines for safe practice. Charts with dosage guidelines for macronutrients and micronutrients provide a helpful reference.
Many of the statements under Compounding of PN Formulations are important for Baxa, its automated compounder customers, and practitioners who prepare and administer parenteral nutrition. Among these are:
- ASPEN recommends standardized PN order forms and standardized labels for PN admixtures (recommended text is included).
- According to the labeling practice guidelines, “The PN label should be compared with the order, and the beyond-use date should be checked before administration.”
- The Standard Nutrient Ranges practice guidelines recommend that “The pharmacist should assess the PN contents to ensure that the dose of all nutrients is appropriate to the patient's needs.”
- For Compounding practice the guidelines recommend:
- Review of PN contents is required to ensure that a balanced and complete formulation is provided.
- Each PN component is assessed for adequacy of dose and potential for a compatibility or stability problem.
- Any dose outside the accepted range and not explained by a specific patient condition should be clarified prior to compounding PN.
- The additive sequence is optimized and validated as a safe, efficacious method.
- A review of the compounding method is recommended if PN is compounded manually or if there has been a change in commercial source of PN products.
- Manufacturers of automated methods of PN compounding should provide the additive sequence that ensures the safety of the compounding device based on the nutrient products used at the institution.
- Gravimetric analysis of PN formulations can be applied, focusing on the most dangerous additives tolerating the least margin of error (e.g., potassium salts).
- Compounding accuracy of PN prepared by automated compounding devices should be verified by end-product testing.
- Aseptic extemporaneous preparation of PN formulations should adhere to the ASHP Guideline on Quality Assurance for Sterile Products.
- According to the PN Administration Guidelines, “Policies and procedures should be in place to deal with PN compounded by an outside facility.”
- The ASPEN Recommendation on Parenteral Nutrition Standardization states, “The evidence on patient safety does not support the general use of standardized PN formulations across healthcare organizations.” “When an organization implements standardized PN formulations (including standardized, commercial PN products), a mechanism should be established to provide, compound, or make available, customized PN formulations for individuals who have complex requirements secondary to disease or underlying illness, or when otherwise warranted by routine monitoring of electrolytes, organ function, growth and development.”
The author summarizes that PN is an effective therapy, noting that, “Optimal use of PN requires careful consideration of the patient's clinical condition and nutritional state and the physical and chemical characteristics of the admixture...use of guidelines for determining the proper indication, mode of delivery, and mode of administration of PN facilitates the provision of the most appropriate nutritional therapy.”
Baxa can help your facility implement best practices for compounding parenteral nutrition through its automated compounders and USP <797> compliance tools. Baxa equipment is supported by a complete Operator Manual and policy and procedure guidelines to help you meet ASPEN and ASHP guidelines for best practice in sterile compounding and parenteral nutrition. Call Baxa at 800-567-2292 to have a representative contact you about the clinical benefits of automated PN compounding.
Return to Newsletter
|