Total parenteral nutrition (TPN) is a high – alert medication and a form of nutrition support it involves the delivery of nutrients through an intravenous catheter into a large central vein or peripheral vein on the hand or arm. Patients who receive total parental nutrition have underlying disorders that involve a non-functioning digestive system. These patients are not able to ingest or absorb food or specialized nutrition products taken by mouth or administered directly into other parts of gastrointestinal tract using a feeding tube. Many adults and children who require TPN are critically ill or may have complex medical disorders or surgical complications.
Indicators for using TPN
Parenteral nutrition process
The TPN process typically involves inter- professional collaboration between dietitians, physicians, pharmacists, and nurses to provide effective and safe nutrition care. Good communication and standardization of process across all steps is an important risk management strategy. Ideally each step within TPN process should follow accepted guidelines and standards of practice with nutrition support specialist in each discipline. GET YOUR ASSIGNMENTS DONE BY TUTORS AT AFFORDABLE PRICES.
TPN process includes a number of critical patient focused steps
Patient assessment: comprehensive nutritional assessment of the patient by the nutrition support service or dietitian, is based on subjective and objective data to determine if TPN is appropriate
Prescribing: this plan is then communicated to a physician or designate who orders the TPN by prescription
Verification and review: The PN prescription is then verified and reviewed by a pharmacist to asses appropriateness of the many PN Ingredients for patient specific dosing
Compounding labelling and dispensing: a TPN order deemed appropriate will be prepared in a pharmacy adhering to stringent guidelines for sterile compounding.
Administration: the prepared TPN is sent to the patient unit for administration to the patient
Monitoring and reassessment: following administration, monitoring and reassessment of the patient by the nutrition service completed the loop
Documentation should take place in each step
Total parenteral nutrition oversight
TPN requires an institutional inter- professional system of oversight by health professionals with specialized expertise in nutrition support. The system ensures development and ongoing monitoring of adherencence to policies, procedures, and practices that are consistent with published leading practice standards and guidelines across all departments involved in TPN process also this oversight should include an ongoing systematic review of all TPN related adverse events, close calls, and hazards to identify deviations from leading practices or standard of care in order to improve safety of institution’s TPN
Parenteral nutrition knowledge and skills within pharmacy.
Leading practice standards for PN safety recommend that pharmacists complete both a clinical and pharmaceutical aspects of TPN. It is recommended that pharmacist be trained through a structured education program with annual competency assessments to demonstrate knowledge and skills the board of pharmacy specialties offers internationally recognized certification on nutrition support.
TPN reporting and learning with pharmacy
A safety culture is often described as including five elements: an informed culture a reporting culture, a learning culture, a just culture, a flexible culture, an informed culture involves collecting and analyzing relevant data regarding factors that affect the safety of a system. Reporting culture involves cultivating an atmosphere where people feel comfortable to report safety concerns a learning culture describes degree in which organization is willing and able to learn from mistakes and make changes as needed. Everyone has an important role to play.
TPN Issues, analysis recommendations and enabling action
Parenteral nutrition is generally not acknowledged to be high-alert medication in the Edmonton zone pharmacy. The TPN ordering templates and processes in use within pharmacies do not comply with recognized leading practices
The sterile compounding facilities in the pharmacies at universities do not comply with sterile compounding standards. The pharmacy departments are not fully optimizing the good catch and reporting learning systems for improving TPN safety
PN is prescribed Edmonton zone using one of the three standardized PN order forms onto which the prescriber hand writes the prescription the order forms were last revised in 1998.Licenced pharmacies are required to comply with practice a quality standard for compounded sterile preparations. Pharmacies introduce their role through an informal, on-the job training process in which knowledge is gained in daily activities.
Ensure provincial use of strategies beyond double check to mitigate pump set-up and programming hazards during preparations and administration. Standardized pharmacy and nursing TPN checking process and implementing double check process to verify. Improve sterile compounding environment to meet established standards. Develop structured training process with annual competency assessment for PN pharmacists. Develop PN-specific policies and standardized procedures within pharmacies
TPN enabling actions
Use the ASPEN TPN safety consensus recommendations, training for all TPN pharmacists and support small teams of pharmacist to develop specialized practice. Conduct a cost/benefit analysis to compare upgrading the current facilities with development of centralized pharmacy with sterile compounding facility. Implement a computerized prescriber order entry system for communicating the PN order.
Advantages of TPN
Disadvantages of TPN
The main disadvantage of total parental nutrition relate to complication rising from the intravenous presence of a foreign body and ability for grater manipulation of nutrients intake thus more tiresome and wearing. It is more expensive due to greater costs of preparing solutions and need for more intensive care, monitoring and higher risk complication.
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