P36 An audit of standardised (NEON) PN use in a tertiary NICU
Authors: To Patrick 
Published: April 2023

The most vulnerable patients on NICU are our extreme preterm babies who require various mechanisms of support during the beginnings of their lives. One method of support is the provision of parenteral nutrition (PN) to these patients.1NICE recommends the use of standardised PN for neonates,2the PN of choice at this Trust is NEON, which was introduced in May 2018. Local guidelines have specific indications for PN, and the management of electrolyte and glucose disturbances.3Our NHS Foundation Trust is a tertiary NICU with a specialism in neonates requiring surgical management of gastrointestinal issues and uses both standardised and bespoke PN. The aim of the audit was to discover if the patients in NICU were receiving NEON PN at the right time, and if any changes to the provision of PN followed the recommendations of local guidelines. This included assessment of; the indication for PN, the timeliness of prescription and administration of PN, the suitability of electrolyte and glucose corrections, and the correct documentation of any discontinuation of standard PN. Data was collected prospectively on working days over 3 weeks in August 2019 on NICU ITU and HDU using a pro-forma that collected key demographic data, including gestational age at birth and starting PN, time of birth, along with indication for PN, and the date and time of PN prescribed and administered. Patients were followed up daily during the data collection period by the NICU pharmacist with changes documented on the pro-forma. Any patients admitted outside of pharmacy working hours (Monday to Friday 0900–1700) were followed up retrospectively by the NICU pharmacist. During the data collection period, 21 patients were admitted onto NICU and 11 patients were identified as suitable for starting NEON PN. All 11 patients received NEON for the correct indications. Only 2 of 5 patients less than 31+0 gestational age received PN on time. All 11 of patients requiring NEON for other indications received it on time. 1 of 3 patients who required electrolyte or glucose changes to NEON were corrected as per guidelines. All 11 patients who switched to bespoke PN or stopped PN had the reasons documented in the notes. The results of this clinical audit showed that whilst all patients were initiated on NEON PN for the correct indications, not all of them received it on time, particularly patients who were less than 31+0 gestational age; local guidelines specify that these patients should have PN initiated within 6 hours of life. Patients with electrolyte or glucose issues were also changed to bespoke PN without following local guidelines. Reasons suggested by the clinical team once the results were fed back included a shortage of staff during the night-time delaying the insertion of appropriate peripheral or central venous catheters, and lack of experienced staff overnight with confidence to administer peripheral PN. Patients who were changed to bespoke PN were done so by consultants who were not well versed in using NEON and insisted on the change.

References

Lissauer T, Carroll W. Illustrated textbook of paediatrics. 5th ed. London: Elsevier; 2018. p172 -173.

National Institute for Health and Care Excellence. Neonatal parenteral nutrition [Internet]. [London]: NICE; 2020 [cited 2022 Jun 9]. (Clinical guideline [NG154]). Available from: https://www.nice.org.uk/guidance/ng154

North West London Operational Delivery Network. Guideline for use of Standard Preterm Parenteral Nutrition in the North West London Operational Delivery Network [Internet]. 2018 [accessed June 2022]. Available from: the local intranet.