Quality standard
Quality statement 1: Standardised bags
Quality statement 1: Standardised bags
Quality statement
Preterm and term babies who are prescribed neonatal parenteral nutrition are started on a standardised bag.
Rationale
Once the decision is made that parenteral nutrition is needed, it should be started as soon as possible to reduce the risk of nutritional deficit developing, particularly in preterm babies. Using a standardised neonatal parental nutrition formulation (standardised bag) enables the early delivery of neonatal parenteral nutrition because it can always be available on neonatal units and easily accessed when needed. Using a standardised bag improves consistency in nutritional care, reduces variation in practice and reduces the risk of errors that can occur when making up individualised prescribed bags.
Quality measures
The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.
Structure
a) Evidence of local arrangements to ensure that standardised bags are available on neonatal units.
Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by provider organisations, for example, stock records and evidence of availability of standardised bags.
b) Evidence of written clinical protocols on the administration of standardised bags, including starting preterm and term babies on standardised bags, and the volume of neonatal parenteral nutrition that should be given.
Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by provider organisations, for example, copies of written protocols.
Process
Proportion of preterm and term babies who are prescribed neonatal parenteral nutrition who are started on a standardised bag.
Numerator – the number in the denominator who are started on a standardised bag.
Denominator – the number of preterm and term babies who are prescribed neonatal parenteral nutrition.
Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from patient records.
Outcome
a) Number of neonatal parenteral nutrition prescribing errors.
Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from patient records and incident reporting.
b) Number of delays in starting neonatal parenteral nutrition.
Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from patient records.
What the quality statement means for different audiences
Service providers (such as neonatal and paediatric units and pharmacy services) ensure that standardised bags, containing the suitable levels of nutritional content as detailed in NICE's guideline on neonatal parenteral nutrition, are easily available for use on neonatal units to ensure neonatal parenteral nutrition can be safely and promptly administered. They ensure that staff use standardised bags for preterm and term babies who are prescribed neonatal parenteral nutrition, and are trained to administer them correctly, including the volume that should be given.
Healthcare professionals (such as neonatal and paediatric consultants and pharmacists) start neonatal parenteral nutrition using a standardised bag as soon as possible after the decision to give it is made.
Commissioners (such as clinical commissioning groups, integrated care systems and NHS England) ensure that they commission services in which standardised bags of neonatal parenteral nutrition are available on neonatal units and used when parenteral nutrition is started.
Newborn babies who need to be given nutrition directly into their bloodstream through a vein (intravenously) are given a type of nutrition that is suitable for most babies called a 'standardised bag'. Standardised bags can be kept on the neonatal unit, so they are ready to use quickly. This avoids delays in giving babies the nutrition they need.
Source guidance
Neonatal parenteral nutrition. NICE guideline NG154 (2020), recommendation 1.6.1
Definitions of terms used in this quality statement
Neonatal parenteral nutrition
Nutrition given directly into the bloodstream through a vein (intravenously) in newborn babies who cannot take adequate milk feeds because they are too small or very unwell. It includes nutrients such as amino acids, glucose, fat, electrolytes, vitamins and trace elements. The neonatal period is defined as up to 28 days after birth for babies born at term and 28 days after their due birth date for those born preterm. [Adapted from NICE's guideline on neonatal parenteral nutrition and expert opinion]
Standardised bags
Standardised bags contain pre-formulated aqueous and lipid parenteral nutrition solutions made to a set composition. They are ready to use and aim to meet the nutritional and clinical needs of a defined group of babies. Additional intravenous infusions are sometimes used to meet more individualised fluid or electrolyte requirements.
A choice of standardised bags is available to ensure that the nutritional and clinical needs of a defined group of babies can be met. [Adapted from NICE's guideline on neonatal parenteral nutrition, terms used in this guideline]