Status of achievement of the aseptic preparation method for total parenteral nutrition expected by physicians and nurses

Abstract

In most medical institutions, although total parenteral nutrition (TPN) should be prepared by pharmacists in sterile condition, nurses actually perform this procedure in hospital wards. The currently growing belief is that pharmacists should prepare all preparations for injection using aseptic technique. Therefore, we conducted a survey on how physicians and nurses feel about methods of preparation of TPN and other agents for injection. The results demonstrated that physicians and nurses desired pharmacists to prepare all agents for injection according to prescriptions using aseptic technique, under pharmacological control and on a 24-hours basis. Based on these results, we examined a method to realize this expectation to the extent possible in our hospital and applied it when aseptic TPN preparations were extended to include relatively stable patients requiring TPN in all hospital wards. The number of TPN preparations increased steadily. The mean number of aseptic TPN preparations after stabilization of this method was 1214 a month. A total of 48% of all TPN solutions required were prepared in aseptic condition, with an average of 4.4 vials of agents mixed per prescription. For TPN base solution, 71% of a double--bag preparation consisting of electrolytes, saccharides, and amino acids was used. It was prepared in the wards most often for the reason, "described as an unscheduled prescription". The cost of consumables required for aseptic preparations was approximately 1.7 times the insurance coverage for addition of aseptic preparations. The physicians and nurses supported the method used by the pharmacists. To ensure complete aseptic preparation of injections by pharmacists, additional pharmacists, a review on their working system, more insurance points, and a broader range of insurance coverage may be required.