Parenteral nutrition: a call to action for harmonization of policies to increase patient safety

Abstract

Unsafe medication practices and medication errors are leading causes of injury and avoidable harm worldwide and are highest in vulnerable groups. In 2017, the World Health Organization launched the third Medication Without Harm Global Patient Safety Challenge to try to reduce risks related to medical treatment. Parenteral nutrition (PN) is in the unique position that, although licensed products are available from manufacturers, formulas may be prepared ad hoc for first-line use that might not be subject to the same regulatory oversight. Safety issues around PN can arise through lack of harmonization in practices, misinterpretation and product unfamiliarity and can occur at any stage from prescription to preparation to administration. Government legislation and regulation vary considerably, with PN not explicitly handled in many countries. We therefore call on policy leaders in all countries to establish policies that ensure patient safety, and that these include PN along with medicines. The available evidence supports obtaining industry prepared PN as first-line therapy for reasons of safety, primarily, and of cost. If a suitable industry prepared ready-to-use PN is not available, standardized all-in-one PN admixtures should be the next line of care, with individualized PN being reserved for patients whose complex nutritional needs cannot be met using standardized admixtures.

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Fig. 1: World Health Organization harm reduction framework for Medication Without Harm.
Fig. 2: Summary of selected policies, regulations and guidelines on compounding of medicines and PN.

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Authors

Contributions

Valery Gallagher: conceptualization, methodology, supervision. David Berlana: writing—review and editing, validation. Mattias Paulsson: writing—review and editing, validation. Rebecca White: methodology, writing—original draft.

Corresponding author

Correspondence to Rebecca Jayne White.

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Conflict of interest

VG is an employee of Baxter Healthcare and, presently serves as a member of the American Society of Parenteral and Enteral Nutrition’s (ASPEN) Corporate Scientific Advisory Council. MP reports personal fees from InBioPharma US/Baxter, Fresenius Kabi Germany, and B Braun Sweden outside the submitted work. DB reports personal fees from Fresenius Kabi and Baxter SL outside the submitted work. RJW is an employee of Baxter Healthcare and is the communication officer for the British Pharmaceutical Nutrition Group.

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Gallagher, V., Berlana, D., Paulsson, M. et al. Parenteral nutrition: a call to action for harmonization of policies to increase patient safety. Eur J Clin Nutr (2020). https://doi.org/10.1038/s41430-020-0669-5

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