Cost, Time, and Error Assessment During Preparation of Parenteral Nutrition: Multichamber Bags Versus Hospital-Compounded Bags.

BACKGROUND: Parenteral nutrition (PN) is associated with material and manpower costs and requires preparation time. The aim of this study was to evaluate the cost of PN using multichamber bags (MCBs) compared with hospital-compounded bags (COBs). The secondary aim of this study was to assess and compare preparation time and errors related to the production and preparation processes of PN bags. MATERIALS AND METHODS: A prospective, observational, cost-accounting study was conducted in 10 Spanish hospital pharmacy services. The cost assessments included components, raw materials, and hospital staff. Only PN bags with equivalent volume and nutrition value were included in the analyses. Assessment of errors related to PN was performed simultaneously with the cost and time comparison analyses. RESULTS: Among the 597 PN bags (295 MCBs, 302 COBs) evaluated, 392 PN bags (295 MCBs, 97 COBs) had an equivalent volume and nutrition value. The mean (standard deviation) total cost of the MCB was $62.11 ($12.34) per bag compared with $67.54 ($8.50) per bag for COBs, resulting in a significant cost savings of $5.71. On average, the time required to prepare an MCB was 38 minutes shorter (P < .001). Significantly fewer total number (percent) of errors was observed in the preparation of MCBs (3 [1.0%]) compared with COBs (15 [5.0%]); P < .01). CONCLUSION: The use of MCBs results in significant savings in cost and preparation time, which may have a beneficial effect on the economic burden associated with PN as well as a reduction in errors related to PN preparation.

Management of the General Process of Parenteral Nutrition Using mHealth Technologies: Evaluation and Validation Study.

BACKGROUND: Any system applied to the control of parenteral nutrition (PN) ought to prove that the process meets the established requirements and include a repository of records to allow evaluation of the information about PN processes at any time. OBJECTIVE: The goal of the research was to evaluate the mobile health (mHealth) app and validate its effectiveness in monitoring the management of the PN process. METHODS: We studied the evaluation and validation of the general process of PN using an mHealth app. The units of analysis were the PN bags prepared and administered at the Son Espases University Hospital, Palma, Spain, from June 1 to September 6, 2016. For the evaluation of the app, we used the Poststudy System Usability Questionnaire and subsequent analysis with the Cronbach alpha coefficient. Validation was performed by checking the compliance of control for all operations on each of the stages (validation and transcription of the prescription, preparation, conservation, and administration) and by monitoring the operative control points and critical control points. RESULTS: The results obtained from 387 bags were analyzed, with 30 interruptions of administration. The fulfillment of stages was 100%, including noncritical nonconformities in the storage control. The average deviation in the weight of the bags was less than 5%, and the infusion time did not present deviations greater than 1 hour. CONCLUSIONS: The developed app successfully passed the evaluation and validation tests and was implemented to perform the monitoring procedures for the overall PN process. A new mobile solution to manage the quality and traceability of sensitive medicines such as blood-derivative drugs and hazardous drugs derived from this project is currently being deployed.

[Nutritional support and parenteral nutrition in the oncological patient: an expert group consensus report]. / Soporte nutricional y nutrición parenteral en el paciente oncológico: informe de consenso de un grupo de expertos Nutritional support and parenteral nutritio.

BACKGROUND: Malnutrition is a frequent medical problem of cancer patients that negatively impacts their quality of life. OBJECTIVE: To analyze and respond to different issues related to the nutritional management of cancer patients in the clinical setting. METHODS: A multidisciplinary group of experts in Medical Oncology, Pharmacy, and Nutrition developed a list of topics related to the nutritional status of cancer patients, which were grouped into three blocks: Nutritional support; Parenteral nutrition (PN); and Home PN (HPN) in cancer patients. A literature search, which included articles published in Spanish, English, and French until February 2017, was carried out. The document was organized as a questionnaire with those questions that, according to the panel's criteria, could generate greater controversy or doubt. RESULTS: Of the 18 questions addressed, 9 focused on nutritional support: 5 were related to PN and 4 about HPN. Among the different recommendations, the panel emphasized that in the cancer patient, PN is indicated mainly when it is not possible to use the digestive tract and/or oral feeding and/or enteral nutrition is not sufficient or possible. Additionally, the objective of the HPN is to improve or maintain the nutritional status of a patient at home. CONCLUSIONS: This document seeks to lay down a set of recommendations and to identify key issues that may be useful for the nutritional management of cancer Patients.

Soporte nutricional y nutrición parenteral en el paciente oncológico: informe de consenso de un grupo de expertos / Nutritional support and parenteral nutrition in cancer patients: An expert consensus report

La desnutrición es un problema médico frecuente de los pacientes oncológicos que impacta de forma negativa en la calidad de vida. El objetivo de este trabajo es analizar y dar respuesta a diferentes cuestiones relacionadas con el manejo nutricional de un paciente oncológico en la práctica clínica. Un grupo multidisciplinar de expertos en Oncología Médica, Endocrinología y Nutrición y Farmacia elaboró una lista de temas relacionados con el estado nutricional del paciente oncológico agrupados en 3 bloques: soporte nutricional, nutrición parenteral (NP) y NP domiciliaria (NPD). Se realizó una revisión de la literatura que incluyó artículos publicados en español, inglés y francés hasta abril de 2017. Este consenso destaca diferentes elementos clave que ayudarán a los médicos a normalizar el manejo del estado nutricional del paciente oncológico en la práctica clínica, estableciendo pautas comunes de indicación, monitorización, requerimientos nutricionales y vías de acceso a la NP

Malnutrition is a common medical problem in cancer patients with a negative impact on quality of life. The aim of this study was to address different issues related to nutritional management of cancer patients in clinical practice. A multidisciplinary group of experts in Medical Oncology, Pharmacy, and Endocrinology and Nutrition prepared a list of topics related to the nutritional status of cancer patients and grouped them into three blocks: nutritional support, parenteral nutrition (PN), and home PN (HPN). A literature review was made of articles published in Spanish, English and French until April 2017. This consensus emphasizes several key elements that help physicians standardize management of the nutritional status of cancer patients in clinical practice, and establishes common guidelines for indication, monitoring, nutritional requirements, and access routes to PN

Soporte nutricional y nutrición parenteral en el paciente oncológico: informe de consenso de un grupo de expertos Nutritional support and parenteral nutritio / Nutritional support and parenteral nutrition in the oncological patient: an expert group consensus report

Introducción: la malnutrición es un problema médico frecuente de los pacientes oncológicos que impacta de forma negativa en la calidad de vida. Objetivo: analizar y dar respuesta a diferentes cuestiones a la hora de afrontar el manejo nutricional de un paciente oncológico en la práctica clínica. Métodos: un grupo multidisciplinar de expertos en Oncología Médica, Farmacia y Nutrición elaboró una lista de temas relacionados con el estado nutricional del paciente oncológico que fueron agrupados en tres bloques: soporte nutricional; nutrición parenteral (NP); y nutrición parenteral domiciliaria (NPD) en el paciente oncológico. Se realizó una revisión de la literatura que incluyó artículos publicados en español, inglés y francés hasta febrero de 2017. El documento se estructuró como un cuestionario con aquellas preguntas que, según el criterio del panel, podrían generar mayor controversia o duda. Resultados: de las 18 cuestiones abordadas, 9 versaron sobre el soporte nutricional: 5 relacionadas con la NP y 4 trataron sobre la NPD. Dentro de las recomendaciones del panel destacar que, en el paciente oncológico, la NP está indicada principalmente cuando no es posible el uso del tubo digestivo y/o la alimentación oral y/o nutrición enteral no es suficiente o posible. Además, el objetivo de la NPD es mejorar o mantener, el estado de nutrición de un paciente en el ámbito domiciliario. Conclusiones: esta revisión constituye una herramienta para oncólogos y especialistas responsables del manejo nutricional del paciente con cáncer (AU)

Background: Malnutrition is a frequent medical problem of cancer patients that negatively impacts their quality of life. Objective: To analyze and respond to different issues related to the nutritional management of cancer patients in the clinical setting. Methods: A multidisciplinary group of experts in Medical Oncology, Pharmacy, and Nutrition developed a list of topics related to the nutritional status of cancer patients, which were grouped into three blocks: Nutritional support; Parenteral nutrition (PN); and Home PN (HPN) in cancer patients. A literature search, which included articles published in Spanish, English, and French until February 2017, was carried out. The document was organized as a questionnaire with those questions that, according to the panel’s criteria, could generate greater controversy or doubt. Results: Of the 18 questions addressed, 9 focused on nutritional support: 5 were related to PN and 4 about HPN. Among the different recommendations, the panel emphasized that in the cancer patient, PN is indicated mainly when it is not possible to use the digestive tract and/or oral feeding and/ or enteral nutrition is not sufficient or possible. Additionally, the objective of the HPN is to improve or maintain the nutritional status of a patient at home. Conclusions: This document seeks to lay down a set of recommendations and to identify key issues that may be useful for the nutritional management of cancer patients (AU)

Development of the management for parenteral nutrition traceability in a standard hospital.

OBJECTIVE: to develop the traceability control and the hazard analysis in the processes of parenteral nutrients (PN). METHOD: a standardized graphical notation was generated, describing in detail each of the stages in the overall process. The presence of hazards was analysed by sequencing decisions. The existence of Control Points (CP) or Critical Control Points (CCP) was estimated by Criticality Index (CI) for each hazard taking into account the probability of occurrence and the severity of the damage. The threshold for the IC was set in 6. RESULTS: a specific flow chart for the management and traceability of PN was obtained, defining each of the stages in CPs (validation and transcription of the prescription and administration) or CCPs (preparation, storage and infusion pump -flow and filter-). Stages regarding the delivery, the recovery and the recycle of the packing material of PNs are not considered CPs and, therefore, they were not included in the dashboard. CONCLUSIONS: PN must be dealt with in the frame of a standardized management system in order to improve patient safety, clinical relevance, maximize resource efficiency and minimize procedural issues. The proposed system provides a global management model whose steps are fully defined, allowing monitoring and verification of PN. It would be convenient to make use of a software application to support the monitoring of the traceability management and to store the historical records in order to evaluate the system.

Objetivo: desarrollar el control de la trazabilidad y el análisis de riesgos en el proceso de mezcla de nutrientes parenterales (NP). Método: se diseñó la notación gráfica normalizada, caracterizando cada una de las etapas dentro del proceso global. Se analizó la presencia de riesgos mediante la secuenciación de decisiones. La existencia de Puntos de Control (PC) o de Puntos Críticos de Control (PCC) se calculó mediante el Índice de Criticidad (IC) para cada uno de los riesgos, teniendo en cuenta la probabilidad del suceso y la gravedad de los daños. El punto de corte del IC se estableció en 6. Resultados: se obtuvo el diagrama de flujo específico para la gestión y trazabilidad de la NP, caracterizándose cada una de las etapas en PC (validación y transcripción de la prescripción y administración) o PCC (preparación, conservación y bomba de infusión -flujo y filtro-). Las etapas de entrega de la NP y de recuperación y reciclado del material de envasado no se consideraron PC y, en consecuencia, no fueron incluidos en el cuadro de gestión. Conclusiones: la NP debe integrarse en un sistema normalizado de gestión con el fin de mejorar la seguridad del paciente y la pertinencia clínica, maximizar la eficiencia de los recursos y minimizar los incidentes procesales. El sistema propuesto permite establecer una gestión global cuyas etapas quedan totalmente caracterizadas, permitiendo su control y verificación. Sería deseable disponer de una aplicación informática que facilitara el seguimiento de la gestión de la trazabilidad y tener un histórico de los registros que permita evaluar el sistema.

Development of the management for parenteral nutrition traceability in a standard hospital / Desarrollo de la gestión de la trazabilidad de la nutrición parenteral en un hospital tipo

Objective: to develop the traceability control and the hazard analysis in the processes of parenteral nutrients (PN). Method: a standardized graphical notation was generated, describing in detail each of the stages in the overall process. The presence of hazards was analysed by sequencing decisions. The existence of Control Points (CP) or Critical Control Points (CCP) was estimated by Criticality Index (CI) for each hazard taking into account the probability of occurrence and the severity of the damage. The threshold for the IC was set in 6. Results: a specific flow chart for the management and traceability of PN was obtained, defining each of the stages in CPs (validation and transcription of the prescription and administration) or CCPs (preparation, storage and infusion pump –flow and filter-). Stages regarding the delivery, the recovery and the recycle of the packing material of PNs are not considered CPs and, therefore, they were not included in the dashboard. Conclusions: PN must be dealt with in the frame of a standardized management system in order to improve patient safety, clinical relevance, maximize resource efficiency and minimize procedural issues. The proposed system provides a global management model whose steps are fully defined, allowing monitoring and verification of PN. It would be convenient to make use of a software application to support the monitoring of the traceability management and to store the historical records in order to evaluate the system (AU)

Objetivo: desarrollar el control de la trazabilidad y el análisis de riesgos en el proceso de mezcla de nutrientes parenterales (NP). Método: se diseñó la notación gráfica normalizada, caracterizando cada una de las etapas dentro del proceso global. Se analizó la presencia de riesgos mediante la secuenciación de decisiones. La existencia de Puntos de Control (PC) o de Puntos Críticos de Control (PCC) se calculó mediante el Índice de Criticidad (IC) para cada uno de los riesgos, teniendo en cuenta la probabilidad del suceso y la gravedad de los daños. El punto de corte del IC se estableció en 6. Resultados: se obtuvo el diagrama de flujo específico para la gestión y trazabilidad de la NP, caracterizándose cada una de las etapas en PC (validación y transcripción de la prescripción y administración) o PCC (preparación, conservación y bomba de infusión -flujo y filtro-). Las etapas de entrega de la NP y de recuperación y reciclado del material de envasado no se consideraron PC y, en consecuencia, no fueron incluidos en el cuadro de gestión. Conclusiones: la NP debe integrarse en un sistema normalizado de gestión con el fin de mejorar la seguridad del paciente y la pertinencia clínica, maximizar la eficiencia de los recursos y minimizar los incidentes procesales. El sistema propuesto permite establecer una gestión global cuyas etapas quedan totalmente caracterizadas, permitiendo su control y verificación. Sería deseable disponer de una aplicación informática que facilitara el seguimiento de la gestión de la trazabilidad y tener un histórico de los registros que permita evaluar el sistema (AU)