Keywords
error chamber
simulation in health
How to Cite
Abstract
Background: Parenteral nutrition (PN) handling is complex and, when performed incorrectly, is associated with several complications. Various studies suggest that institutions adopt methods to prevent errors by the responsible professionals, reducing the inherent risks. SAFE-PN is a healthcare simulation tool using an error chamber, where researchers intentionally make mistakes for practice and understanding of systems, actions, or interactions. Objective: To evaluate the error detection capacity during PN handling by healthcare professionals and students in the fields of Pharmacy and Pharmaceutical Sciences; to propose a method for assessing competencies in sterile handling. Methods: The error chamber, in asynchronous video format, was made available through a website and disseminated through social and professional networks and/or email. Participants could view the video and access the Microsoft Forms® questionnaire through the same website, where they could report all detected errors. Participation was voluntary, with informed consent. Results: The reported results were categorized by error type in a Microsoft Excel® file. Results: 34 valid responses were considered – 94.12% of participants detected at least one error in the category “Non-conformities related to hygiene practices and conduct in a controlled environment”; 85.29% of participants detected at least one error in the category “Putting on personal protective equipment (PPE)”; 82.35% of participants detected at least one error in the category “Work surfaces and their sanitization”; 32.35% of participants detected at least one error in the category “Incompatibilities and interactions”; 52.94% of participants detected at least one error in the category “Use of volume measuring devices and puncture devices”; 55.88% of participants detected at least one error in the category “Performing controls”. Conclusions: The study was successfully completed, providing a tool for evaluating trainees in the field.
References
1. Abraitis, J., & Goff, L. L. (2025, maio). Adding Medicines to Parenteral Nutrition (PN). https://chopib.staywellsolutionsonline.com/Bedside/22,32046
2. Association of Surgial Technologist. (2017, abril). AST Guidelines for Best Practices for Wearing Jewelry. https://www.ast.org/uploadedfiles/main_site/content/about_us/standard%20wearing%20jewelry.pdf
3. Bachenheimer, B. S. (2019). Manual for Pharmacy Technicians (American Society of Health-System Pharmacists, Vol. 5).
4. BBRAUN. (sem data). Mini-Spike®, Mini-Spike® V, Mini-Spike® Micro-tip. Obtido https://www.bbraun.ie/en/products/b1/mini-spike-mini-spikevmini-spikemicro-tip.html
5. Berlana, D. (2022, outubro). Parenteral Nutrition Overview—PubMed. https://pubmed.ncbi.nlm.nih.gov/36364743/
6. Bispo, R. (sem data). Partículas em Injetáveis—Qualificação de Processos de inspeção e Controlo de Contaminação. Hikma Farmacêutica, Portugal. Obtido https://www.ordemfarmaceuticos.pt/fotos/editor2/2023/_www/eventos/raci/8._apresentacao_raci_rosa_bispo.pdf
7. Boullata, J. I., Mirtallo, J. M., Sacks, G. S., Salman, G., Gura, K., Canada, T., & Maguire, A. (2022, fevereiro). Parenteral nutrition compatibility and stability: A comprehensive review—PubMed. https://pubmed.ncbi.nlm.nih.gov/34788478/
8. Campos, D., Silva, I., Rego, M., Correia, P., & Moreira, F. (2024). Characterization of education, technical practices and attitudes of Portuguese pharmacy technicians towards manipulation of cytotoxic drugs. https://journals.sagepub.com/doi/10.1177/10781552231190025
9. Carvalho, S., Cardoso, A., Ferreira, D., & Moreira, F. (2024). Controlo de qualidade de soluções de ciclofosfamida preparadas com agulha ou com spike®: Desenvolvimento e aplicação de método por HPLC-DAD para controlo quantitativo. https://recipp.ipp.pt/entities/publication/25f3da8d-7322-436f-bd12-73f376b5eec0
10. Cober, M. P., Tucker, A. M., & Derenski, K. (2016). Strategies for Successful Parenteral Nutrition Order Writing. https://www.ashp.org/-/media/assets/pharmacy-practice/resource-centers/Clinical-Pharmacy-Resources/Nutrition-Support/2016-MCM/MCM16-335-Strategies-for-Successful-Parenteral-nutrition.pdf
11. Constantinidis, T. C., Vagka, E., Dallidou, P., Basta, P., Drakopoulos, V., Kakolyris, S., & Chatzaki, E. (2010, dezembro). Occupational health and safety of personnel handling chemotherapeutic agents in Greek hospitals. https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1365-2354.2009.01150.x
12. Council on Pharmacy Standards. (sem data). 4.3 IV Room Workflows and Safety Controls – Council on Pharmacy Standards. Obtido 26 de março de 2026, de https://pharmacystandards.org/chppc/section-4-3-iv-room-workflows-and-safety-controls/?PageSpeed=noscript?PageSpeed=noscript
13. Deliberação n 057 CD 2022—INFARMED, I.P. (2022, junho 30). https://www.infarmed.pt/documents/15786/5355901/Delibera%C3%A7%C3%A3o+n+057+CD+2022/7eeffaac-c6b3-dc4e-098a-96dbddcf4a4c
14. Dhingra, N. (com Safe Injection Global Network & World Health Organization). (2010). WHO guidelines on drawing blood: Best practices in phlebotomy. Safe Injection Global Network, World Health Organization.
15. Dille, E. (2023, outubro). Horizontal vs Vertical LAFWs: Which is Best for my Pharmacy? https://www.fagronacademy.us/blog/horizontal-vs-vertical-lafws-which-is-best-for-my-pharmacy
16. European Commission. (2022, agosto). The Rules Governing Medicinal Products in the European Union Volume 4 EU Guidelines for Good Manufacturing Practice for Medicinal Products for Human and Veterinary Use. https://health.ec.europa.eu/document/download/e05af55b-38e9-42bf-8495-194bbf0b9262_en?filename=20220825_gmp-an1_en_0.pdf
17. Garnier, A., Butaye, L., Bonnabry, P., & Bouchoud, L. (2023). A room of errors simulation to improve pharmacy operators’ knowledge of cytotoxic drug production—PubMed. https://pubmed.ncbi.nlm.nih.gov/36748798/
18. ISO 7886-1. (2017). Sterile hypodermic syringes for single use—Part 1: Syringes for manual use. https://www.iso.org/obp/ui/es/#iso:std:iso:7886:-1:ed-2:v2:en
19. Jukes, A., Gallagher, K., Arnold, S., Hughes, S., Marini, S., & Thomas, A. (2023, setembro). Parenteral Nutrition Procedures for Adult Patients. https://cavuhb.nhs.wales/files/policies-procedures-and-guidelines/corporate-policy/p-q-corporate-policy/uhb-450-parenteral-nutrition-procedures-for-adult-patients/
20. Kris M. Mogensen, Malcolm K. Robinson, & Glenn D. Braunstein. (2025, dezembro). Nutrição parenteral (NP)—Distúrbios nutricionais—Manuais MSD edição para profissionais. https://www.msdmanuals.com/pt/profissional/dist%C3%BArbios-nutricionais/suporte-nutricional/nutri%C3%A7%C3%A3o-parenteral-np
21. Loboda, C., Vigneron, J., Mulot, C., May, I., & Demore, B. (2019). A «chamber of errors» adaptation to assess pharmaceutical assistants’ knowledge in chemotherapy preparation—PubMed. https://pubmed.ncbi.nlm.nih.gov/29237326/
22. Manual da Farmácia Hospitalar—INFARMED, I.P. (2005). https://www.infarmed.pt/web/infarmed/institucional/documentacao_e_informacao/publicacoes/tematicos/manual-da-farmacia-hospitalar
23. Matos, M. S. D. de. (2004, março). Cuidados de Enfermagem ao Doente com Necessidade de Nutrição Parenteral. Escola Superior de Enfermagem de Coimbra | ESEnfC. https://web.esenfc.pt/v02/pa/conteudos/downloadArtigo.php?id_ficheiro=216&codigo=
24. Mourato, B. V. M. E. (2013). CONTROLO DE QUALIDADE DE FORMAS FARMACÊUTICAS ESTÉREIS. Universidade Lusófona de Humanidades e Tecnologias Faculdade de Ciências e Tecnologias da Saúde. https://recil.ulusofona.pt/server/api/core/bitstreams/7b7bc6fe-6c73-48a6-9d57-8355fc0b56bb/content
25. Ogino, M. H., & Tadi, P. (2023, julho). Cyclophosphamide. https://pubmed.ncbi.nlm.nih.gov/31971727/
26. OSHA. (2011). Protecting Yourself When Handling Contaminated Sharps.
27. R. Barbosa, A. Capela, C. Sampaio, S. Fraga, & T. Soares. (sem data). Automatização em nutrição parentérica: Controlo de qualidade antes e após a sua implementação. Obtido 23 de março de 2026, de https://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1699-714X2021000100006
28. Simmons, J. (2024, dezembro). Laminar Flow Hood: Essential Cleaning Tips and Best Practices—Plant Cell Technology. https://plantcelltechnology.com/blogs/blog/laminar-flow-hood-essential-cleaning-tips-and-best-practices
29. Sousa, A., Martins, C., Freitas, O., & Lourenço, R. (sem data). Manual de Nutrição Artificial—Normas Profissionais—Publicações—Ordem dos Farmacêuticos. Obtido 23 de março de 2026, de https://www.ordemfarmaceuticos.pt/pt/publicacoes/normas-profissionais/manual-de-nutricao-artificial/
30. UNC - Eshelman School of Pharmacy. (sem data). Sterile Compounding. Pharmlabs. Obtido 26 de março de 2026, de https://pharmlabs.unc.edu/labexercises/compounding/sterile/atech/
31. USP. (2019, dezembro). Pharmaceutical Compounding—Sterile Preparations. https://www.uspnf.com/sites/default/files/usp_pdf/EN/USPNF/revisions/gc-797-postponement-rb-notice-20191122.pdf
Watrobska-Swietlikowska, D. (2019, julho). Compatibility of Maximum Inorganic and Organic Calcium and Phosphate Content in Neonatal Parenteral Solutions. https://pubmed.ncbi.nlm.nih.gov/31324864/
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