Assignment Total Parenteral Nutrition (TPN)

Total Parenteral Nutrition (TPN)

Introduction

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.

Assignment help Total Parenteral Nutrition (TPN)

Indicators for using TPN

• Any infant requiring major surgery before establishment of milk feeds and as soon as after surgery.
• Malabsorption-short gut intractable diarrhea, villous atrophy, dysmotitlity syndrome.
• GI perfusion compromised by condition such as cardiovascular or respiratory instability, and use of certain medication.
• Non-functional gastrointestinal tract
• Inflammatory bowel disease where enteral nutrition has failed to prevent or reverse malnutrition

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

TPN Issues

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

TPN analyses

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.

TPN recommendations

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

1. Intravenous injection is deemed to be the effective way to administer drugs and its contents since they are injected directly to the blood. The drug doesn’t need to be ingested then digested the absorbed by blood
2. Less medicine is used I TPN since the medicine is injected as a solution using syringe and components get deliver directly to the blood, less  medicine is used in the process unlike ingested medicine which you have to account for losses during digestion.
3. Allow nutrition support when GI intolerance prevents oral or enteral support.

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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