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An audit of total parenteral nutrition prescribing for children
  1. A. Luhar
  1. Pharmacy Department, Birmingham Children's Hospital, Birmingham, UK

Abstract

Objective Birmingham Children's Hospital (BCH) pharmacy team identified a need to audit Parenteral Nutrition (PN) prescriptions as a high number of prescriptions contained missing components which required the team to make interventions and amendments based on previous PN requirements with minimal guidance from the prescriber. PN can have potentially fatal complications therefore it is vital that prescriptions state all the necessary components required with no omissions and must be unambiguous. In accordance with the Trust Medicines Policy,1 all prescriptions should be unambiguous; the prescriber's intention should be clear and contain no omissions. The aim of this audit was to assess compliance with the Medicines Policy, to quantify the level of omissions and assess prescriber's views on PN training and confidence in prescribing.

Methods Data were gathered retrospectively spanning a 2 week period. All patients receiving PN in this period were examined. An audit proforma was designed to record omitted components. If the prescriber's intention for the requirements were unclear this was also documented. Prescriptions were defined as ‘intention unclear’ if the prescriber had omitted components and not stated ‘no change from previous date’ on the prescription. A questionnaire was also sent to all PN prescribers to gain qualitative information about their PN training and confidence in prescribing.

Results 86 prescriptions were received from four specialties. 78% of prescriptions were defined as unclear. A high proportion of prescriptions (84–92%) did not have the nutritional components (macronutrients, electrolytes, vitamins) fully prescribed. An equally high proportion (83%) did not specify the route of administration as central or peripheral. Over half of the prescriptions did not have the patient's weight recorded or the total fluid needed. 62% of the prescriptions did not state the duration of the PNA small proportion (7%) of the prescriptions were not signed resulting in further interventions from pharmacy. 12% of PN prescribers had received no training. Half of the prescribers had received training in the form of hospital induction training. Over a third of prescribers received training classed as ‘other’ training. This consisted of ‘on-the-job’ training and previous experience from other Trusts. 87% of prescribers felt that they would like further training in PN prescribing.

Conclusion This audit has demonstrated poor adherence to the Trust Medicines Policy. A high proportion of prescriptions have omitted components and the prescriber's intention is therefore unclear. This audit highlights the need for increased training of PN prescribers and increased awareness of the Medicines Policy. There is a need for further work to evaluate whether PN prescribing should be limited to a nutritional team as recommended by other studies such as National Confidential Enquiry into Patient Outcome and Death.2

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