Impact of BCNSP-led parenteral nutrition management on prescribing errors in the neonatal intensive care unit

Background: Parenteral nutrition (PN) preparations are listed as high-alert medications and have a high probability of medication errors (MEs). Board-certified Nutrition Support Pharmacists (BCNSPs) can play an important role in reducing PN-associated complications by highlighting the gaps in the PN prescribing process. This study aimed to determine the impact of BCNSP-led PN review on the identification and documentation of prescribing MEs (PMEs) to optimize quality and safety in PN prescribing processes. Methods: This QI quasi-experimental study included all neonates admitted to a level III neonatal intensive care unit (NICU) and prescribed PN. All identified and recognized PN-PMEs documented by pharmacists were evaluated in pre-and post-implementation-phases. In the pre-phase, the PN-duty pharmacist reviewed all the neonatal PN-orders while located in the pharmacy, and in the post-phase, a clinically involved BCNSP performed this task. All PN-PMEs were categorized into ten types. Predictors of PN-PMEs were analyzed through logistic regression. Results: PN-orders were prescribed to 98 and 112 neonates in pre-and post-phases, respectively. For demographic and clinical variables, neonates were comparable. A median of 12 (range = 9 − 19) vs. 15 (range = 12–22) PN-orders/day were reviewed in pre-and post-phases. Documented PN-PMEs for all PN orders were significantly higher in the post-phase (212/2577, 8.23%) compared with the pre-phase (25/2577, 0.97%; p < 0.001). “Wrong Dose/Calculation” was the most reported category (88/2577, 3.41%). “Wrong concentration range” was the second highest (29/1309, 2.22%) and all were reported only in post-phase. Additional errors involved infusion, compatibility, and osmolarity deviations, renal/hepatic dose adjustment errors and stability errors. Most of them were only identified in the post-phase. Post-phase outcomes showed clinically meaningful reductions in metabolic derangements, NICU stay, and mortality (p < 0.001). Conclusion: The engagement of BCNSPs in the clinical neonatal setting for PN management may improve the safety and efficacy of PN-therapy.