Abstract:

Parenteral nutrition (PN) is defined as a form of nutrition that is delivered into a vein, thus dismissing the need to use the digestive system for nutritional purposes. PN was introduced in clinical practice in the late 1960s and is necessary when patients cannot receive adequate nutrition orally or by enteral tubbing, to treat or prevent malnutrition. PN formulations commercially available cannot always be administered directly to patients, requiring some reconstitution procedure before administration. There are also many cases (especially among neonates), in which commercial solutions are not available at all, thus requiring total compounding of the admixture. The compounding of PN is considered one of the most challenging tasks performed by pharmacy professionals working in hospital units. Unfortunately, there have already been reports of serious injuries and even deaths related to errors related to this task. Therefore, pharmacy students and professionals who intend to compound PN should not only be subject to specific training programs but also assessment. A previously described method of assessing technical skills for the preparation of other sterile solutions consisted of the so-called “chamber of errors”. In this simulation, the individuals being assessed watched in loco a set of manipulation procedures in which errors were deliberately made by a member of the training team. It was intended that the trainees identified the errors that have been committed. This work aims to develop the protocol for the creation of an asynchronous assessment program for compounding PN admixtures based on a video simulation of an adapted version of the “chamber of errors”. A search through PubMed and Web of Science for papers describing training and assessment on PN compounding or knowledge requirements among pharmacy professionals compounding PN was performed to identify minimum specific contents to be included in an assessment program. Only papers published between 2004 and 2023 were included. Expert evaluation methodologies were also researched to identify strategies to validate the preliminary developed instrument. Based on the collected information, a preliminary document depicting specific contents to be included in the “chamber of errors” simulation was developed.

In short, specific contents include:
(i) aseptic technique,
(ii) accurate measurement of volumes,
(iii) compatibility between components,
(iv) adequate use of puncture devices, and
(v) correct manipulation of glass ampoules.

The Delphi method was elected for the validation of the preliminary instrument, and a panel of between 20 and 50 professionals will be formed. The inclusion criteria for the experts will be experience equal to or greater than 10 years in compounding PN and higher education in the field of pharmacy. After validation of the contents, a video-based “chamber of errors” will be created, to enable an asynchronous assessment of pharmacy students and professionals. It is expected that this health simulation will have a positive impact, allowing individuals to experience a representation of a real event of PN compounding. Given that it is an asynchronous tool, it is hoped that it will have a greater reach in educational institutions or hospitals, thus promoting the fulfillment of demanded knowledge assessment.

Keywords:

Parenteral Nutrition, Pharmacy, Aseptic technique, Simulation based-learning, Health education.