Discrepancies Between Prescribed and Actual Pediatric Home Parenteral Nutrition Solutions.
BACKGROUND
Home parenteral nutrition (HPN) is increasingly prescribed for pediatric patients with complex medical conditions. Commercial vendors are widely available to compound HPN. The aim of this study was to determine the frequency of discrepancies between written HPN prescriptions and commercially compounded solutions, as well as to record the associated severity of harm from discrepancies.


METHODS
From January to April 2013, 2 clinical pharmacists independently and prospectively reconciled HPN compounding records with electronic prescriptions (gold standard) during all routine ambulatory encounters to a multidisciplinary HPN program. Types, severity, and causes of discrepancies were recorded.


RESULTS
Sixty-one unique patients were identified for inclusion during 117 visits. HPN solutions were compounded at 13 unique vendors across 14 states. Of all 100 compounding records, 46 (46%) contained at least 1 discrepancy, with a total of 60 discrepancies identified, affecting 34 of 61 (56%) patients. There was at least 1 discrepancy in solutions originating from 10 of 13 (77%) home infusion companies. Discrepancies were classified as Medication Error Reporting and Prevention levels C (n = 37) and D (n = 23; ie, all reaching patient but not causing harm).


CONCLUSIONS
We found an alarmingly high rate of preparation discrepancies in a cohort of pediatric patients receiving HPN. Routine reconciliation of HPN compounds with intended prescriptions may be critical for ambulatory patients receiving this high-risk therapy. While home infusion commercial vendors provide an indispensable function, discrepancies and errors with potential for harm may be more common than previously appreciated.
Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, Massachusetts, USA bram.raphael@childrens.harvard.edu.
Bram P
BP
Raphael
Department of Pharmacy, Boston Children's Hospital, Boston, Massachusetts, USA.
Margaret
M
Murphy
Department of Pharmacy, Boston Children's Hospital, Boston, Massachusetts, USA.
Kathleen M
KM
Gura
Clinical Research Center, Boston Children's Hospital, Boston, Massachusetts, USA.
Heather
H
Litman
Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, Massachusetts, USA.
Meghan K
MK
Dalton
Division of General Pediatrics, Department of Medicine Quality Program, Boston Children's Hospital, Boston, Massachusetts, USA.
Jonathan A
JA
Finkelstein
Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, Massachusetts, USA.
Jenifer R
JR
Lightdale
D002675:Child, Preschool; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008508:Medication Errors / Q000706:statistics & numerical data*; D057947:Parenteral Nutrition Solutions / Q000592:standards*; D016331:Parenteral Nutrition, Home / Q000706:statistics & numerical data*; D010595:Pharmacists / Q000706:statistics & numerical data; D011446:Prospective Studies
D057947:Parenteral Nutrition Solutions
compounding; home total parenteral nutrition; medication errors; parenteral nutrition; parenteral nutrition solutions