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Background and Importance Automated compounding systems (ACS) for parenteral nutrition (PN) aid the bag preparation process. In our hospital setting, the ACS integrates a nutrient volumes deviation detection system. Identifying these discrepancies is crucial as they may compromise patient safety, causing hydroelectrolytic imbalances, volume alterations, and metabolic dysfunctions.Aim and Objectives The objective of this study is to analyse deviations identified during PN bag compounding and to define a standardised clinical decision making procedure involving the hospital pharmacist (HP) and the prescribing physician (PP) for assessing bag suitability.Material and Methods Data related to bag compounding performed at a hospital between January 2025 and July 2025 were extracted from the ACS software. Data were categorised by production date, clinical ward, patient population (adult/paediatric), compounding deviation type and percentage, and proportion of validated versus rejected bags. For deviations between 2-4%, the HP consulted with the PP to assess bag suitability based on the patient‘s laboratory parameters and clinical status. Bags with deviations exceeding 4% were systematically discarded and re-compounded.Results During the study period, a total of 1898 nutritional bags were compounded. Of these, 91/1898 (4.8%) showed a filling deviation exceeding 2%. The magnitude of the detected deviation ranged between 2-25% in 79 bags, 25-50% in seven bags, and exceeded 50% in five bags. Following joint decision making between the HP and the PP, considering the patient‘s laboratory values and clinical conditions, 64/91 bags were deemed suitable for administration as the deviation was not considered clinically significant. The remaining 27/91 bags were rejected. The main reasons for discarded bags were significant variations in sodium quantity (15 bags), excessive concentration of disodium fructose diphosphate in bags for preterm neonates (three bags), and potassium overdosage in paediatric emergency bags (nine bags).Conclusion and Relevance The analysis confirmed that a 2% threshold procedure with systematic multidisciplinary evaluation based on laboratory and clinical parameters effectively ensures safe nutritional therapy. This approach proved essential for vulnerable populations, highlighting the fundamental role of interprofessional collaboration in preventing clinically significant errors in ACS which could affect patient outcomes.Conflict of Interest No conflict of interest