Parenteral nutrition in hospital pharmacies.
Purpose - The purpose of this paper is to explore parenteral nutrition (PN) practices in hospital pharmacies of Kuwait and identify potential avenues for quality improvement in this service. Design/methodology/approach - A descriptive, qualitative study about PN practices was conducted from June 2012 to February 2013 in Kuwait. Data were collected via in-depth semi-structured interviews with the head total parenteral nutrition (TPN) pharmacists at seven hospitals using a developed questionnaire. The questionnaire obtained information about the PN service at each hospital including the existence of nutritional support teams (NSTs), PN preparation practices, quality controls and guidelines/protocols. The interviews were audio-recorded, transcribed verbatim and analyzed for content. Findings - Seven hospitals in Kuwait provided PN preparation service through TPN units within hospital pharmacies. Functional NSTs did not exist in any of these hospitals. All TPN units used paper-based standard PN order forms for requesting PN. The content of PN order forms and PN formulas labeling information were inconsistent across hospitals. Most of the prepared PN formulas were tailor-made and packed in single compartment bags. Quality controls used included gravimetric analysis and visual inspection of PN formulations, and less consistently reported periodic evaluation of the aseptic techniques. Six TPN units independently developed PN guidelines/protocols. Originality/value - This study revealed variations in many aspects of PN practices among the hospitals in Kuwait and provided recommendations to improve this service. Standardization of PN practices would enhance the quality of care provided to patients receiving PN and facilitate national monitoring. This can be accomplished through the involvement of healthcare professionals with expertise in nutrition support working within proactive NSTs.
Department of Pharmacology and Therapeutics, Faculty of Pharmacy, Kuwait University, Kuwait.
Maram Gamal
MG
Katoue
Department of Pharmacy Practice, Faculty of Pharmacy, Kuwait University, Kuwait.
Dalal
D
Al-Taweel
Department of Pharmacology and Therapeutics, Faculty of Pharmacy, Kuwait University, Kuwait.
Kamal Mohamed
KM
Matar
Department of Pharmacology and Therapeutics, Faculty of Pharmacy, Kuwait University, Kuwait.
Samuel B
SB
Kombian
D000328:Adult; D002985:Clinical Protocols; D004339:Drug Compounding / Q000379:methods; D005260:Female; D006801:Humans; D007730:Kuwait; D008297:Male; D008875:Middle Aged; D010288:Parenteral Nutrition / Q000379:methods* / Q000592:standards; D010348:Patient Care Team / Q000458:organization & administration; D010607:Pharmacy Service, Hospital / Q000458:organization & administration* / Q000592:standards; D017410:Practice Guidelines as Topic; D036301:Qualitative Research; D011786:Quality Control; D058996:Quality Improvement / Q000458:organization & administration*
Hospital pharmacy; National health service; Parenteral nutrition; Quality assessment; Quality controls; Quality improvement; Safe practice; Service delivery; Service quality; Standards