Authors (including presenting author) :
Chiu GS (1), Hsieh KM (1), Ho WS (1), Li KC (1), Bo SW (1), Hau WL (1), Chan YY (1), Lee WM (1), Kwan M (1), Kan M (1)
Affiliation :
(1) Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital.
Introduction :
Total Parenteral Nutrition (TPN) is a complex, high-alert medication as it contains lipid emulsions, dextrose, amino acids, vitamins, electrolytes, minerals and trace elements. Therefore, errors associated with the use of TPN may lead to significant harm to patient. The premature babies in Neonatal Intensive Care Unit (NICU) have immature function and motility of gastrointestinal tract, thus TPN is commonly used while enteral feeding is being gradually advanced. There were TPN related incidents occasionally occurred in recent years, and three incidents related to TPN infusion were reported to the Advanced Incident Reporting System (AIRS) between June and August 2022. Therefore, improvement strategies should be implemented to ensure safe practice throughout the process from ordering to administrating of TPN in NICU.
Objectives :
(1) To reinforce nurses’ strict compliance in standard of Administration of Medication (AOM);
(2) To enhance communication of dispensing of TPN and handover of correct TPN to right patient;
(3) To redesign and standardize the workflow from ordering, preparing, checking to administrating of TPN;
(4) To rectify system error.
Methodology :
(1) Establish a Continuous Quality Improvement (CQI) Team including nurses with different years of experience and conduct literature review on safe practice in TPN
(2) Identified the root causes and practice gaps of the recent 3 incidents related to TPN infusion, included: (a) communication error, (b) Non-compliance in AOM procedure and system error
(3) Implemented immediate action included (a) develop visual signage on similar patient’s name or Twin/Triplet; and (b) rectify the irrelevant default setting from the infusion pump
(4) Reviewed the existing competence performance checklist on administration of TPN to cover good practice and conducted a large scale audit by using this revised checklist to all NICU nurses.
(5) Redesigned and implemented the standardized workflow on the whole process from ordering to administrating the TPN
(6) Enhanced staff awareness on safe practice in TPN by incident sharing and continuous monitoring.
Result & Outcome :
The improvement strategies on safe practice in TPN for NICU’s babies have been fully implemented in December 2022. The irrelevant default setting from the infusion pump was immediately disabled in September 2022. All NICU staffs have passed the competence assessment on TPN administration by using the revised checklist by November 2022, and no incident has been reported after the implementation of the standardized TPN workflow. Furthermore, the CQI team would act as safety warden to monitor the staffs’ compliance and assess the effectiveness of the improvement strategies regularly.
