P16 Audit on initiation, prescribing, and administration on standardised, concentrated, additional macronutrients, parenteral nutrition

Aims To assess the level of adherence with current local guidelines for the initiation, prescribing, and administering of SCAMP1 in the neonatal intensive care unit (NICU) and special care baby unit (SCBU) in a district general hospital.2–4 Method All patients in NICU/SCBU across both sites of the local Trust during 1st April 2021 to 31st March 2022, were listed via BadgerNet retrospectively, and filters were applied to screen patients who would fit the parenteral nutrition (PN) initiation criteria - All infants born Results There was poor compliance to all standards - none of which reached 100% - but most notably with the initiation of PN within the timeframe where the compliance rate was 12.7%. Other criteria included initiation of PN within neonates that fulfilled the criteria, documentation of party which made decisions, total fluid requirement, glucose side arms and administration timings. A lack of documentation was apparent throughout the project from all aspects which contributed to the poor compliance rate. During the audit 32.1% of prescriptions were found to have errors, most of which were around wrong calculations of volumes and rates. These were amended by a pharmacist prior to administration. It highlighted the importance of a neonatal pharmacist but also the need to ensure calculations are done correctly. There was a difference in practice cross site as seen in the difference in compliance to standards 1, 3, 4, and 5. In particular, the 11.2% of patients not started on PN when it was indicated were mostly from Site 2, suggesting clinician preference and therefore a need to align practice across sites. Conclusions In summary, most PN prescriptions were not initiated, prescribed, and/or administered as per guidelines. There were differences in practice cross-site but no identifiable trend across corrected gestation at birth. References Morgan C, Herwitker S, Badhawi I, et al. SCAMP: standardised, concentrated, additional macronutrients, parenteral nutrition in very preterm infants: a phase IV randomised, controlled exploratory study of macronutrient intake, growth and other aspects of neonatal care. BMC Pediatr 2011;11:53. Lewisham and Greenwich NHS Trust. Clinical Guideline – Parenteral Nutrition for Infants on NICU/SCBU. Online publication 2019. https://lgnet.lewishamandgreenwich.nhs.uk/download.cfm?ver=22635 (Accessed 20 September 2022). London Core Neonatal Nutrition Group for London ODN. Guideline for use for Standard Parenteral Nutrition: SCAMP. 14th May 2018. National Institute of Health and Care Excellence. Neonatal Parenteral Nutrition. Online publication. 2020. https://www.nice.org.uk/guidance/ng154 (Accessed 27 October 2022).