Compounding Parenteral Nutrition: A Need for Precision
Parenteral nutrition demands a high level of attention and precision; without them the results can be fatal. Instances of bacterial contamination and even data entry errors in compounding parenteral nutrition have led to fatalities. This is why it is so crucial to have a trusted provider of compounding supplies for your parenteral nutrition needs, as well as all of the requisite skill. The personal attention and high level of precision that a compounding pharmaceutical provider affords parenteral nutrition products makes custom compounding the best option for these patient needs.
Basics of Compounding Parenteral Nutrition
Parenteral nutrition (PN) is absolutely essential to many pediatric interventions. It is used in support of the nutritional needs of patients who cannot meet their own nutritional, growth, and metabolic needs for any reason. Typically reasons for this inability might be that their gastrointestinal tract is ineffective due to disease, inaccessible due to physical defect, or otherwise unusable. Pediatric patients who most often receive PN include bone marrow transplant patients, children with serious gastrointestinal problems such as short bowel syndrome, critically ill children, pediatric oncology patients, pediatric surgery patients, and prematurely born infants.
Both prescribing for PN patients and compounding their PN solutions are involved, demanding processes. There are certain standardized PN bags that are commercially available which require a minimum of additional compounding work before use. Most complicated cases, however, require bags that are entirely customized to be compounded on-site every day. Obviously at large institutions, such as those with sizable neonatal intensive care units or hospice wards, PN compounding accounts for a great deal of work. At these institutions compounding is often mostly automated and makes use of volumetric pump systems. This is not to say that any less skill or judgment is required, however.
Bags of compounded PN solution generally contain an excess of 10 components. Compounding these together demands personnel who are very experienced, including both pharmacists and technicians who are familiar with the process. Proper compounding facilities are also essential, as contamination is a serious risk. And while the use of automatic compounding devices is alleged to lower the risk of human error, these should not be used as a crutch.
The Risks of Automation
For example, in the case of an infant who was being sustained with PN, on the day of the fatality the treating physician prescribed 14.7 mEq of sodium chloride and 982 mg of calcium to be used in the PN solution. The pharmacy technician erred and entered the data into automated compounder software as 982 mg of sodium, not calcium. The solution was then prepared using the automated compounder and was affixed with a label reflecting the wrong amount (again, in error). Later, a different label showing the originally prescribed amounts was applied over the incorrect label and no one noticed this inconsistency. Because the label looked correct, the nurse who administered the solution did not know the solution was not right. Unfortunately, the infant died from cardiac arrest due to the mistake.
The harsh reality is that automated equipment cannot change the facts: skilled professionals must be using that equipment with their full attention and with the best quality materials in an appropriate setting for completely safe results.
The Need for Compounding Pharmaceutical Providers
Some research has shown that standardization of PN that is commercially available is often inappropriate for patients in many delicate clinical settings. Furthermore, cost limitations that force healthcare providers to rely on these “one-size-fits-all” solutions make treatment inconsistent in terms of quality. This research suggests that a better solution for cost management is for healthcare providers to make use of compounding specialists for their PN needs, outsourcing very specialized orders to save on their own labor and facility costs.
Other research indicates that premixed parenteral formulations tend to vary significantly, between 9 and 15 percent for carbohydrate and protein content respectively on average. Furthermore, the data shows that premixed micronutrients were available in only one formulation and so could not easily be compared to custom compounded parenteral formulations. The research all points to the fact that only custom compounding provides individualized nutrition for patients. And where costs are factored heavily into the equation, the need can still be met by both in-house compounding specialists and outsourced special orders.
This use of specialized compounding pharmaceutical providers would also help to ensure higher quality products. And since the majority of PN patients — 69 percent according to research — do require customized PN, pharmaceutical providers capable of meeting these needs will be positioned to fill a niche for these large healthcare institutions.
Is your pharmacy in need of compounding ingredients? Pharmaceutica North America would like to be your resource for high-quality compounding products for all your compounding needs. For more information regarding products available through PNA, please contact our very knowledgeable and friendly team.