Abstract
AbstractParenteral nutrition (PN) in the neonatal intensive care unit (NICU) involves a succession of risky processes. The objective was to identify and prioritize the risks associated with PN in order to improve the quality of the pathway. A failure modes, effects, and criticality analysis (FMECA) was used to identify potential PN pathway failure modes. A multidisciplinary working group conducted a functional analysis of the processes, then listed the failure modes (FM). The FM criticality was assessed on a scale from 1 to 5 for occurrence (O), severity (S), and detection (D). The risk priority number (RPN), ranging from 1 to 125, was calculated. The FMECA identified 99 FM (prescription (n=28), preparation (n=48), and administration (n=23)). The median RPN was 12, with scores ranging from 3 to 48. 25 % of the scores had an RPN>21.75.Among them, 12 were associated with prescription FM, 5 were associated with FM related to preparation and 8 were associated with a FM linked to administration. It allowed us to prioritize areas of potential quality improvement for parenteral nutrition of the preterm infant. The results demonstrated the need for the presence of a clinical pharmacist in the NICU to ensure the quality of PN process.
Highlights
Preterm infants are highly vulnerable to malnutrition
The results demonstrated the need for the presence of a clinical pharmacist in the neonatal intensive care unit (NICU) to ensure the quality of parenteral nutrition (PN) process
The aim of the study was to carry out a risk analysis of the whole parenteral nutrition process using a failure modes, effects, and criticality analysis (FMECA) method and select action priorities to improve quality based on results
Summary
Preterm infants are highly vulnerable to malnutrition. The energy intake necessary to ensure their growth is very high during this period (45–120 kcal/kg/day according to the post-natal age) [1, 2]. Enteral nutrition through breast milk should be preferred when the digestive tract is functional, improving preterm infant growth and reducing adverse events related to central catheter lines [1]. The PN pathway is a complex combination of high-risk activities. It involves various persons (physicians, pharmacists, pharmacy technicians, nurses) in various geographical locations (NICU, pharmacy) which increase the risk of adverse events and medication errors. The main failure modes (FM) identified was the lack of electronic prescription and its transcription for preparation [8]. These 2 risks are present in our establishment
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