Proposed Topic (Most preferred): :
Clinical Safety and Quality Service II (Projects aiming to enhance clinical safety and outcomes, clinical governance / risk management)
Proposed Topic (Second preferred): :
Clinical Safety and Quality Service I (Projects aiming to improve efficiency and effectiveness of care delivery to meet international standards)
Authors (including presenting author) :
Wong KY(1), Chiu GS(1), Lee WM(1), Yip C(2), Ng CYA(1), Leung SK(1), Wong SCM(1), Jalal K(1), Wong H(2)
Affiliation :
(1) Department of Paediatric and Adolescent Medicine, Queen Mary Hospital (2) Department of Pharmacy, Queen Mary Hospital
Introduction :
Preterm infants have limited nutrient reserves at birth, they required parenteral nutrition(PN) to meet their nutritional requirements if they cannot tolerate sufficient enteral feeds. It is recommended that PN should be initiated promptly after birth to minimize catabolism and improve growth outcomes. When tailor-made PN is not available, ready-made standard PN will be used. There is prolonged waiting time from acquisition to administration of standard PN due to long transit time of standard PN from pharmacy. Therefore, a quality improvement project to achieve early initiation of PN to newborn preterm infants was started in December 2022.
Objectives :
(1) To reduce the time of initiation of PN of newborn preterm infants by 30% (2) To reduce the time between confirmation of central line position to initiation of PN by 60% (3) To reduce the non-value added time from acquisition to administration of standard PN by 30 minutes (4) No incidence due to expired PN or inappropriate storage temperature of PN (5) To reduce the staff workload related to acquisition of standard PN
Methodology :
(1) A multidisciplinary workgroup, which included nurses, doctors and clinical pharmacist, was formed to discuss this project. (2) With collaboration of nurses and pharmacists, a standardized workflow was developed and implemented on 1st February 2023, which included: -Change of storage location of standard PN to from pharmacy to NICU -Regularly monitoring of the temperature of the drug fridge used for PN storage -Mechanism for regular checking expiry date of standard PN and replenishment of PN -Contingency plan when standard PN was out of stock or special requisition of extra standard PN during long holiday. (3) A retrospective chart review was performed from October 2022 to May 2023, which included 24 preterm infants.
Result & Outcome :
Primary outcomes of this project were: (1) The time of initiation of PN reduced by 1.75 hours, which was 31%. (2) The time between confirmation of central line position to initiation of PN reduced by 39 minutes, which was 67%. (3) The non-value-added time from acquisition to administration of PN was reduced by 35 minutes. (4) No incidence related to inappropriate storage temperature of standard PN or expired standard PN. Secondary outcome of this project was: (1) For each acquisition of a standard PN, the working time of pharmacist reduced by 10 minutes. (2) Hospital porter service was not required in the new workflow, which indicated staffs’ workload reduction.
