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Optimizing parenteral nutrition practices: Impact of a pharmacist-led quality improvement program on prescription
Haili Shan1, Wei Hu1, Yulu Hong2
1Department of Pharmacy, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Background:
Parenteral nutrition is a crucial clinical therapy, yet its inappropriate use is widespread. Pharmacists play an irreplaceable role in the rational application of drugs. This study assessed the impact of a pharmacist-led improvement project on optimizing the rational use of parenteral nutrition drugs.
Method:
A pharmacist-led improvement program for parenteral nutrition orders was implemented from 2022 to 2023. It included baseline assessment, root cause analysis, and implementation of intervention measures such as staff training, process standardization, and information technology enhancement. 400 cases (200 cases both before and after the intervention) were obtained from the electronic medical records (EMRs) for analysis. Rationality was assessed via administration and nutrient composition. Work efficiency was evaluated by comparing the time spent by physicians and pharmacists on designing, saving, and reviewing the parenteral nutrition orders.
Results:
The proportion of total nutrient admixture (TNA) orders increased fourfold, from 18.5% to 73.5%, while multibottle systems (MBSs) decreased from 73.0% to 1.5% (P < 0.001). The utilization rate of multichamber bags (MCBs) increased from 7.5% to 23.5%, whereas the rate of incorrect use decreased from 53.3% to 0% (P < 0.001). The dose of amino acids increased from 36.56 g to 45.81 g per prescription, while the daily dose increased from 0.64 to 0.79 g/kg/d (P < 0.001); The fat energy to non-nitrogen energy decreased from 0.79 to 0.58 (P < 0.001). Physicians' time to design and save a customized prescription decreased by 2.8 minutes, and pharmacists' time to review it decreased by 0.76 minutes, both reductions being statistically significant (P < 0.05).
Conclusion:
The pharmacist-led multidisciplinary approach can significantly enhance the appropriate use of parenteral nutrition drugs and improve the work efficiency of medical staff.
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