Jpen Parenter Enter
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Parenteral nutrition (PN) is a high-alert medication that contains dozens of active pharmaceutical ingredients. This complex prescription drug preparation is used in a wide variety of clinical settings for patients across the age spectrum. Despite the existence of a number of guidance documents, the drug-use process for PN suffers from lack of standardization for order prescription, order verification and review, PN compounding, labeling, and dispensing. As a result, PN-associated medication errors would not be unexpected but are documented infrequently.
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Jpen Parenter Enter · Mar 2012
Comparative StudyPercutaneous endoscopic gastrostomy complication rates and compliance with the American Society for Gastrointestinal Endoscopy guidelines for the management of antithrombotic therapy.
The American Society for Gastrointestinal Endoscopy (ASGE) has published recommendations in regards to anticoagulant (AC) and antiplatelet (AP) therapy management during endoscopic procedures. So far, no study has assessed either ASGE recommendation compliance during percutaneous endoscopic gastrostomy (PEG) placement or procedure-associated complication rates as related to the observance of these recommendations. The aims of this study were to compare the incidence and type of complications during PEG placement in patients receiving or not receiving AC and/or AP therapy and to determine the compliance with ASGE's AC and AP management guidelines. ⋯ Overall PEG placement complication rate was 13.7%. AP therapy may be safely discontinued closer to the time of endoscopic procedure than the time currently recommended by the ASGE guidelines.
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Jpen Parenter Enter · Mar 2012
Comparative StudyParenteral nutrition prescribing processes using computerized prescriber order entry: opportunities to improve safety.
The prescribing and processing of parenteral nutrition (PN) orders for pediatric patients may involve multiple steps, be time-consuming, and have opportunity for error if safety measures are not in place. The process can vary from institution to institution. The authors conducted a comparison of their system for the prescribing and processing of PN orders with the American Society for Parenteral and Enteral Nutrition's (A. ⋯ There was a 5% overall pharmacist intervention rate on PNs, similar to the 6%-8% rate seen with other medications. Approximately 6% of these PN interventions had an outcome associated with preventing an adverse drug reaction, toxicity, or medication error. Implementation of additional safety measures and standardization may have a positive impact on the complicated process of prescribing and processing PN orders at the authors' institution.
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Jpen Parenter Enter · Mar 2012
Is indirect calorimetry a necessity or a luxury in the pediatric intensive care unit?
Critically ill children differ in their energy needs from healthy children in terms of underlying metabolic derangement, comorbidities, energy reserve, and response to illness. This study determined how many pediatric intensive care unit (PICU) patients were candidates for indirect calorimetry (IC), per American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) recommendations. ⋯ Three of 4 patients were candidates for IC per A.S.P.E.N. guidelines. PICUs might have to prioritize performing IC in patients who are <2 years of age, malnourished (underweight/overweight) on admission, or PICU stay of >5 days. Future studies should determine the cost-benefit ratios of performing IC in PICU patients.
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Jpen Parenter Enter · Mar 2012
Comparative StudyCompounding vs standardized commercial parenteral nutrition product: pros and cons.
Standardized commercial parenteral nutrition (PN) formulations have advantages and disadvantages as compared with PN formulations compounded using an automated compounding device. These advantages and disadvantages are discussed along with the supporting available research.