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Senterre T, van den Akker CHP, Domellof M, Saenz de Pipaon M, Arnell H, Tabbers M, Valla FV, Tomlin S, Paulsson M, Wackernagel D, Haiden N, Luukkainen P, Orfeo L, Carnielli VP, Rigo J. Safe and efficient practice of parenteral nutrition in neonates and children aged 0-18 years - The role of licensed multi-chamber bags. Clin Nutr 2024; 43:1696-1705. [PMID: 38823267 DOI: 10.1016/j.clnu.2024.05.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 04/11/2024] [Accepted: 05/12/2024] [Indexed: 06/03/2024]
Abstract
Parenteral nutrition (PN) is recognized as a complex high-risk therapy. Its practice is highly variable and frequently suboptimal in pediatric patients. Optimizing care requires evidence, consensus-based guidelines, audits of practice, and standardized strategies. Several pediatric scientific organizations, expert panels, and authorities have recently recommended that standardized PN should generally be used over individualized PN in the majority of pediatric patients including very low birth weight premature infants. In addition, PN admixtures produced and validated by a suitably qualified institution are recommended over locally produced PN. Licensed multi chamber bags are standardized PN bags that comply with Good Manufacturing Practice and high-quality standards for the finished product in the frame of their full manufacturing license. The purpose of this article is to review the practical aspects of PN and the evidence for using such multi-chamber bags in pediatric patients. It highlights the safety characteristics and the limitations of the different PN practices and provides some guidance for ensuring safe and efficient therapy in pediatric patients.
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Affiliation(s)
- Thibault Senterre
- Baxter R&D Europe, Braine-l'Alleud, Belgium; University of Liège, Liège, Belgium.
| | - Chris H P van den Akker
- Department of Pediatrics - Neonatology, Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Amsterdam, the Netherlands; Amsterdam Reproduction and Development and Amsterdam Gastroenterology Endocrinology Metabolism Research Institutes, Amsterdam, the Netherlands.
| | - Magnus Domellof
- Department of Clinical Sciences, Umeå University, Umea, Sweden.
| | - Miguel Saenz de Pipaon
- Instituto de Investigación Sanitaria del Hospital Universitario La Paz - IdiPAZ, (Hospital Universitario La Paz - Universidad Autónoma de Madrid), Madrid, Spain.
| | - Henrik Arnell
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Astrid Lindgren Children's Karolinska University Hospital, Stockholm, Sweden; Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
| | - Merit Tabbers
- Amsterdam Reproduction and Development and Amsterdam Gastroenterology Endocrinology Metabolism Research Institutes, Amsterdam, the Netherlands; Department of Pediatric Gastroenterology, Hepatology and Nutrition, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
| | - Frederic V Valla
- Transversal dietetics and Nutrition Unit and Nutrition Unit (UTDN), Intensive Care Nutrition, Hospices Civils de Lyon, Lyon-Bron, France.
| | - Stephen Tomlin
- Pharmacy Department, Children's Medicines Centre, Great Ormond Street Hospital for Sick Children, London, UK.
| | - Mattias Paulsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
| | - Dirk Wackernagel
- Department of Neonatology, Gutenberg University, Mainz, Germany; CLINTEC, Karolinska Institutet, Stockholm, Sweden.
| | - Nadja Haiden
- Department of Neonatology, Kepler University Hospital, Linz, Austria.
| | | | - Luigi Orfeo
- Neonatal Intensive Care Unit, Isola Tiberina Hospital Gemelli Isola, Rome, Italy.
| | - Virgilio P Carnielli
- Department of Mother and Child Health, Division of Neonatology, G. Salesi Children's Hospital - Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona, Ancona, Italy; Department of Odontostomatologic and Specialized Clinical Sciences, Polytechnic University of Marche, Ancona, Italy.
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Mistry P, Fox A, Latter S. National evaluation of harm associated with patient safety incident reports related to the provision of parenteral nutrition to patients, using a national incident reporting system. Nutr Clin Pract 2023; 38:1392-1408. [PMID: 37063048 DOI: 10.1002/ncp.10989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 02/06/2023] [Accepted: 03/13/2023] [Indexed: 04/18/2023] Open
Abstract
BACKGROUND Parenteral nutrition (PN)-related patient safety incidents have been associated with harm. Large-scale studies are scarce, and little is known about contributory factors. This study evaluated PN-related incident reports that described harm using a national database. MATERIALS AND METHODS A retrospective evaluation of incident reports involving PN in England and Wales reported to the National Reporting and Learning System between 2015 and 2020. We described frequency by degree of reported harm and incident characteristics. Content analysis was undertaken to understand contributory factors for reports related to moderate/severe harm or death. RESULTS 12,907 incident reports were identified. After screening, 2242 were evaluated; 1879 (83.8%) reported no harm, 309 (13.8%) low harm, 47 (0.02%) moderate harm, 4 (0.002%) severe harm, 3 (0.001%) deaths. The most reported age group, medication process, and error category were neonates (<28 days) (n = 570/1923, 29.6%), administration (n = 1126/2242, 50%), and omitted medication/ingredient (n = 291/2242, 13%), respectively. Content analysis of reports related to moderate/severe harm and death revealed patient age of <1 year, dependence on home PN (HPN), comorbidities, and staff errors as contributory factors. CONCLUSIONS This is the first evaluation of PN-related incident reports in England and Wales to our knowledge. We demonstrated a low frequency of reports related to moderate or severe harm or death. More incidents were reported for neonates and during the administration processes. To reduce harm, systems/procedures that reduce errors in high-risk patients (eg, neonates, patients receiving HPN) need to be established within organizations. Database limitations of voluntary reporting systems were recognized.
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Affiliation(s)
- Priya Mistry
- Pharmacy Department, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- School of Health Sciences, University of Southampton, Southampton, UK
| | - Andy Fox
- Pharmacy Department, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Sue Latter
- School of Health Sciences, University of Southampton, Southampton, UK
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Kuitunen S, Saksa M, Tuomisto J, Holmström AR. Medication errors related to high-alert medications in a paediatric university hospital - a cross-sectional study analysing error reporting system data. BMC Pediatr 2023; 23:548. [PMID: 37907939 PMCID: PMC10617051 DOI: 10.1186/s12887-023-04333-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 09/27/2023] [Indexed: 11/02/2023] Open
Abstract
BACKGROUND Paediatric patients are prone to medication errors, and only a few studies have explored errors in high-alert medications in children. The present study aimed to investigate the prevalence and nature of medication errors involving high-alert medications and whether high-alert medications are more likely associated with severe patient harm and higher error risk classification compared to other drugs. METHODS This study was a cross-sectional report of self-reported medication errors in a paediatric university hospital in 2018-2020. Medication error reports involving high-alert medications were investigated by descriptive quantitative analysis to identify the prevalence of different drugs, Anatomical Therapeutic Chemical groups, administration routes, and the most severe medication errors. Crosstabulation and Pearson Chi-Square (χ2) tests were used to compare the likelihood of more severe consequences to the patient and higher error risk classification between medication errors involving high-alert medications and other drugs. RESULTS Among the reported errors (n = 2,132), approximately one-third (34.8%, n = 743) involved high-alert medications (n = 872). The most common Anatomical Therapeutic Chemical subgroups were blood substitutes and perfusion solutions (B05; n = 345/872, 40%), antineoplastic agents (L01; n = 139/872, 16%), and analgesics (N02; n = 98/872, 11%). The majority of high-alert medications were administered intravenously (n = 636/872, 73%). Moreover, IV preparations were administered via off-label routes (n = 52/872, 6%), such as oral, inhalation and intranasal routes. Any degree of harm (minor, moderate or severe) to the patient and the highest risk classifications (IV-V) were more likely to be associated with medication errors involving high-alert medications (n = 743) when compared to reports involving other drugs (n = 1,389). CONCLUSIONS Preventive risk management should be targeted on high-alert medications in paediatric hospital settings. In these actions, the use of intravenous drugs, such as parenteral nutrition, concentrated electrolytes, analgesics and antineoplastic agents, and off-label use of medications should be prioritised. Further research on the root causes of medication errors involving high-alert medications and the effectiveness of safeguards is warranted.
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Affiliation(s)
- Sini Kuitunen
- HUS Pharmacy, HUS Helsinki University Hospital, Helsinki, Finland.
- Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland.
| | - Mari Saksa
- Tuulos Community Pharmacy, Tuulos, Finland
| | - Justiina Tuomisto
- Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
| | - Anna-Riia Holmström
- Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
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Bello V, Bodo E, Merlo S. Optical Identification of Parenteral Nutrition Solutions Exploiting Refractive Index Sensing. SENSORS (BASEL, SWITZERLAND) 2022; 22:6815. [PMID: 36146162 PMCID: PMC9503036 DOI: 10.3390/s22186815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 08/26/2022] [Accepted: 09/06/2022] [Indexed: 06/16/2023]
Abstract
Parenteral artificial nutrition (PAN) is a lifesaving treatment for a large population of patients affected by different diseases, and it consists of intravenous injection of nutritive fluids by means of infusion pumps. Wrong PAN solutions are, unfortunately, often administered, thus threatening the patients' well-being. Here, we report an optofluidic label-free sensor that can distinguish PAN solutions on the basis of their volumetric refractive index (RI). In our system, a monochromatic light beam, generated by a laser diode, travels obliquely through a transparent, square-section polystyrene channel, is then back-reflected by a mirror, and finally exits the channel in a position that depends on the filling fluid RI. The displacement of the output light spot ΔXexperim is easily detected with a linear, 1-D position sensitive detector (PSD). We initially calibrated the sensor with water-glucose solutions demonstrating a sensitivity S = ΔXexperim/Δn = 13,960 µm/RIU. We then clearly distinguished six commercial PAN solutions, commonly administered to patients. To the best of our knowledge, this is the first reported healthcare sensing platform for remote contactless recognition of PAN fluids, which could be inserted into infusion pumps to improve treatment safety, by checking the compliance to the prescription of the fluid actually delivered to the patient.
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Affiliation(s)
| | | | - Sabina Merlo
- Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Via Ferrata 5, 27100 Pavia, Italy
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Muluneh AG, Merid MW, Gelaye KA, Tilahun SY, Teshager NW, Abereha AY, Sugamo KS, Yimer MA, Kassa GM. More Than Three-Fourths of AstraZeneca (ChAdox1 COV-19) COVID-19 Vaccinated Individuals Develop Post Immunization Adverse Event in Northwest Ethiopia. Infect Drug Resist 2022; 15:2409-2416. [PMID: 35535029 PMCID: PMC9078864 DOI: 10.2147/idr.s360605] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 04/21/2022] [Indexed: 12/23/2022] Open
Abstract
Background Ethiopia was using the ChAdOx1 COV-19 vaccine, and health professionals were targets of the first phase of the vaccination strategy. Evidence on the adverse events following immunization (AEFI) was barely available. The study aimed to assess the magnitude and associated factors of adverse events following ChAdOx1 COV-19 immunization among health professionals of the University of Gondar Specialized and Comprehensive Hospital, 2021. Methods An institution-based cross-sectional study was conducted among health professionals of the University of Gondar Comprehensive and specialized referral hospital. All health professionals who took the ChAdOx1 COV-19 vaccine in the 1st phase were surveyed. A total of 314 health professionals who took the ChAdOx1 COV-19 vaccine were included. The EpiData version 4.6.0.0 and Stata 16 were used for data entry and analysis, respectively. A binary logistic regression was used to identify statistically significant factors associated with AEFI. Chi-square and multicollinearity assumptions were tested. A p-value <0.2 and 0.05 were used as cut-off values of significance in the bi- and multivariable logistic regression models, respectively. An adjusted odds ratio (AOR) with 95% CI was reported for statistically significant variables. Results Among 314 study participants, 263 of them had at least one mild to severe AEFI of ChAdOx1 COV-19 with a prevalence of AEFI of 83.76% (95% CI: 79.23, 87.46). The commonest AEFI observed were injection site tenderness (n=198/263), fatigue (114/263), headache (n=107/263), and muscle pain (n=85/263). Females (AOR=2.75, 95% CI: 1.15, 6.58), and participants who felt the vaccine was unsafe (AOR=2.84, 95% CI: 1.03, 7.85) were having nearly three times more odds of AEFI immunization as compared to males and those who felt the vaccine was safe, respectively. Conclusion Adverse event following immunization has been a public health problem in Northwest Ethiopia. Being female and having a feeling that the vaccine is unsafe were statistically significantly associated with AEFI.
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Affiliation(s)
- Atalay Goshu Muluneh
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- Correspondence: Atalay Goshu Muluneh, Email
| | - Mehari Woldemariam Merid
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Kassahun Alemu Gelaye
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Sewbesew Yitayih Tilahun
- Department of Psychiatry, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Nahom Worku Teshager
- Department of Pediatrics and Child health, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Aklilu Yiheyis Abereha
- Department of Surgery, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Kalkidan Samuel Sugamo
- Department of Internal medicine, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mulugeta Ayalew Yimer
- Department of Pediatrics and Child health, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Getahun Molla Kassa
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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