P42 All-in-one parenteral nutrition: a national survey
Authors: Phipps Amy 
Published: August 2020

Aims

To gather details about the current usage of All-in-One (AIO) Parenteral Nutrition (PN) for children in the UK, reasons that organisations have switched to using AIO PN and benefits that occurred. For organisations not using AIO PN, the aim is to find out if they have plans to use it in the future and why/not. The ultimate aim is to determine whether AIO PN should be used locally and/or nationally via standardised paediatric PN to improve patient safety.

Background

Conventional split-phase PN is subject to ‘rate switch’ errors when lipid is infused at the rate intended for aqueous PN and vice versa. A 2017 alert from NHS Improvement (NHSI) highlighted that serious adverse effects have occurred due to overly-rapid infusion of PN in babies and children. Using AIO PN eliminates the risk of rate switch errors although there is scant evidence in literature of enhanced safety. A project group has been developing national standardised paediatric PN, with work ongoing. Local rate switch incidents, the NHSI alert and a desire to provide appropriate national standardised PN are the drivers behind this survey.

Methods

A survey monkey® was designed and circulated to members of the Neonatal and Paediatric Pharmacists Group (NPPG) via email. Members were asked to respond on behalf of their organisation if they provided PN to babies or children. The survey included 10 questions/fields, with discrete choices such as yes/no/don’t know or ‘select all that apply’.

Results

51 responses were received from 48 organisations. Close to 50% were using AIO PN for inpatients. Organisations using AIO PN: 70% used both AIO and split-phase PN. AIO PN was used mainly for larger children: adolescents/children >40 kg (64% of organisations); children 30–39.9 kg (60%); and children 20–29.9 kg (48%). Nurse preference/ease of administration (45%), addressing a local safety concern (25%) and responding to the NHSI safety alert (21%) were the most common reasons for using AIO PN. AIO PN was perceived as having a positive impact including: improved patient safety (42% of organisations); improved local aseptic unit capacity (38%); and improved nurse satisfaction (29%). Methods of providing AIO PN included: locally prepared-licensed multi-chamber bag with additions (54%); externally prepared-as bespoke/scratch (39%); licensed multi-chamber bag without additions (39%); externally prepared-standard bag (12%); externally prepared-licensed multi-chamber bag with additions (12%); locally prepared-as bespoke/scratch either using a compounder or via other method (8% each). Organisations not using AIO PN: 43% of organisations were not planning to use AIO PN or didn’t know and 15% planned to start in the future. 42% selected ‘other’ and gave comments, primarily relating to avoiding AIO PN for neonates, e.g. need to use neonatal network PN (split-phase) or prefer flexibility to stop lipid in case of adverse effects. Eleven organisations answered, ‘Why are you thinking of using AIO PN?’ – examples included releasing aseptic capacity, reducing administration errors/improving safety and the long shelf life of triple-chamber AIO bags.

Conclusion

AIO PN appears to be an appropriate and safe for local use and should be taken into account in national standard paediatric PN formulation design where practicable.