Because PN administration errors occur at the point of patient contact, mistakes in this phase of the medication delivery process are less likely than other types of PN errors to be intercepted, and more likely to cause harm. Data pertaining to the incidence of errors related to PN administration are scarce. A recent survey revealed that 44% of organizations do not track PN-related medication errors and do not know where in the process errors may be happening.
The literature does provide some insight into the scope of the problem, however. In one prospective observational study of errors associated with parenteral nutrition, 35% of PN-related errors occurred during the administration process. A similar audit of 18,588 PN days in a tertiary pediatric hospital found that administration-related errors accounted for 30% of all PN errors. In addition, case reports of PN-related errors suggest that neonatal and pediatric patients may be most vulnerable to PN administration errors.
The broad range of healthcare settings in which PN administration takes place—from critical care to home care—raises the potential for disparities to exist in the knowledge and skills of the nursing staff responsible for PN administration. Regardless of the setting, or the number of patients receiving the therapy in a given facility, the classification of PN as a high-alert medication requires healthcare organizations to implement measures to provide the infrastructure for safe PN administration, develop evidence-based policies and procedures related to PN administration, and to provide comprehensive education for nursing staff and lay caregivers responsible for delivering this complex form of intravenous therapy.
Identify common types of PN administration errors.
Describe system-based strategies to enhance the safety of PN administration.
List factors that promote or inhibit the use of the PN Safety Consensus Recommendations in the administration phase of PN.
Propose action items to promote use of the PN Safety Consensus Recommendations for PN administration.
PharmD, BCNSP, FMSHP, FASHP,
Chief, Clinical Pharmacy Services,
Department of Pharmacy, Mississippi Baptist Medical Center, Jackson, MS
Assistant Director, Education and Research,
Department of Pharmacy Services, University of Michigan Health System; Clinical Professor, University of Michigan College of Pharmacy, Ann Arbor, MI
MD, ScM, PNS, FASPEN,
Director Medical Nutrition; Associate Professor of Medicine; Institute of Human Nutrition,
Columbia University Irving Medical Center, New York, NY