A Mnemonic for Pharmacists to Ensure Optimal Monitoring and Safety of Total Parenteral Nutrition: I AM FULL

Abstract

Objective: To present a guideline-derived mnemonic that provides a systematic monitoring process to increase pharmacists' confidence in total parenteral nutrition (TPN) monitoring and improve safety and efficacy of TPN use.

Data sources: The American Society for Parenteral and Enteral Nutrition (ASPEN) guidelines were reviewed. Additional resources included a literature search of PubMed (1980 to May 2016) using the search terms: total parenteral nutrition, mnemonic, indications, allergy, macronutrients, micronutrients, fluid, comorbidities, labs, peripheral line, and central line. Articles (English-language only) were evaluated for content, and additional references were identified from a review of literature citations.

Study selection and data extraction: All English-language observational studies, review articles, meta-analyses, guidelines, and randomized trials assessing monitoring parameters of TPN were evaluated.

Data synthesis: The ASPEN guidelines were referenced to develop key components of the mnemonic. Review articles, observational trials, meta-analyses, and randomized trials were reviewed in cases where guidelines did not adequately address these components.

Conclusions: A guideline-derived mnemonic was developed to systematically and safely manage TPN therapy. The mnemonic combines 7 essential components of TPN use and monitoring: Indications, Allergies, Macro/Micro nutrients, Fluid, Underlying comorbidities, Labs, and Line type.

Keywords: medical mnemonic; medication safety; parenteral nutrition; total parenteral nutrition.