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Patient Safety Incidents Related to the Use of Parenteral Nutrition in All Patient Groups: A Systematic Scoping
Priya Mistry1, Rebecca Heather Smith2, Andy Fox3
1Pharmacy Department, University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD, UK. Priya.mistry5@nhs.net.
Insights
Patient safety incidents in parenteral nutrition (PN) are diverse, affecting all age groups and medication stages. Further research is needed to understand and prevent these critical events.
Area of Science:
- Clinical Pharmacy
- Patient Safety
- Nutritional Support
Background:
- Limited comprehensive literature exists on patient safety incidents associated with parenteral nutrition (PN).
- Understanding the full spectrum of PN-related safety events is crucial for improving patient care.
Purpose of the Study:
- To systematically review patient safety incidents linked to parenteral nutrition across all age demographics.
- To identify common themes and areas for improvement in PN administration.
Main Methods:
- A systematic literature search was conducted in MEDLINE, CINHAL, and Embase databases (January 2000 - April 2020).
- Included studies focused on avoidable PN-related patient safety incidents across all patient populations.
- Two independent authors screened the literature.
Main Results:
- 108 records were analyzed, including case studies, observational, and experimental studies.
- Incidents spanned all medication processes (prescribing to monitoring) and involved contamination, access, and product components.
- Paediatric patients, particularly neonates, were highly represented, with some studies indicating more severe outcomes in this group.
Conclusions:
- Parenteral nutrition administration involves a wide array of patient safety incidents across all age groups and medication process stages.
- A national study focusing on PN patient safety incidents in England is recommended.
- Implementing standardized processes and technological tools may mitigate risks.
Introduction:
There is limited comprehensive literature focussing on the range of patient safety incidents related to parenteral nutrition (PN).
Objective:
The aim of this review was to examine patient safety incidents related to the use of PN in all patient age groups.
Methods:
Literature published in the English language between January 2000 and April 2020 were searched across the MEDLINE, CINHAL and Embase databases. Articles were included if they contained PN-related patient safety incidents related to an avoidable event. No restrictions were applied to patient populations. The screening process was undertaken independently by two authors.
Results:
In total, 108 records were included in the review: 52 case studies, 54 observation studies (e.g. prevalence studies, surveys) and two experimental studies. All age groups were represented, with 62% of studies in paediatrics (of which two-thirds were neonates) and 23% in adults. They included all medication processes: prescribing, dispensing, compounding, administration and monitoring. Incidents were related to microbial contamination, venous access and specific components (e.g. lipid emulsion, amino acids, glucose, micronutrients and electrolytes) or the whole product. Incident outcomes ranging from near miss to death were reported. Intervention studies looked at the impact on patient safety incidents of computerised tools, healthcare processes, e.g. pharmacist screening, and standardisation. One study demonstrated more severe outcomes with paediatric than with adult PN.
Conclusions:
This review demonstrates the vast range of PN-related patient safety incidents in all patient age groups and all medication process stages. The need for a national study looking at patient safety incidents related to PN in England is highlighted.
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