If a total parenteral nutrition (TPN) consultation service is provided the following standards are applicable:
| (a) | Intravenous feeding should only be used when nutritional support by the gastrointestinal tract is impossible or inadequate. |
| (b) | A multi-disciplinary Nutrition Advisory Team may be formed in each hospital to develop policies for nutrition support. Prior to initiation of TPN therapy, a member of the Nutrition Advisory Team should assess whether TPN is appropriate and the adequate base-line laboratory data should have been obtained. |
| (c) | Parenteral nutrition compounding services form part of the range of services available to the Nutritional Advisory Team. Specialist knowledge is required for the formulation and preparation of TPN solutions and for monitoring TPN therapy. Only personnel trained in pharmaceutical aseptic technique and registered with Council must prepare such solutions (refer previous chapter). |
| (d) | The Nutrition Advisory Team may comprise clinicians, pharmacists, nurses and dieticians. Other disciplines may be included to reflect local requirements. |
| (e) | The Nutritional Advisory Team must develop policies for: |
| (i) | The indications for TPN therapy; |
| (ii) | the education of personnel involved in TPN therapy; |
| (iii) | the prescribing of TPN therapy; |
| (iv) | the formulation, preparation and administration of TPN solutions; |
| (v) | the monitoring of patients receiving TPN therapy; and |
| (vi) | the care of central venous catheters. |
| (f) | Prior to initiation of TPN therapy individual patients must be assessed by the team to ensure that TPN is appropriate and adequate baseline laboratory data has been obtained. |
| (g) | The pharmacist must check the TPN prescription for the following: |
| (i) | Correct route and rate of administration; |
| (iii) | stability and/or compatibility of constituents; and |
| (iv) | interaction with other medicines. |
| (h) | The pharmacist must be responsible for ensuring that the dosage calculations are correct and that the mixture will not result in any chemical or physical incompatibility. |
| (i) | Completed TPN solutions must be inspected, where appropriate, for particulate matter before they are issued for administration to the patient. |
| (j) | The pharmacist must take an active part in monitoring the progress of patients receiving TPN therapy including: |
| (i) | The response to TPN therapy to determine if it is adequate; |
| (ii) | the detection and/or prevention of complications; |
| (iii) | the adherence to correct IV administration procedures; |
| (iv) | that batch control records are complete; and |
| (v) | that solutions are protected from light during administration when appropriate. |
| (k) | Quality control testing must be conducted to monitor TPN procedures. The quality assurance programme must be designed to evaluate the performance of equipment, personnel and procedures and include where applicable testing of the final product and remnants returned from the ward. |
