Parenteral Nutrition Compounding Practices at Work

Health-system pharmacies can regulate cost-effective and efficient operations for parenteral nutrition compounding practices. Laura Mark, MS, PharmD, FASHP, led a tech talk at the Baxter Booth at the ASHP Midyear Clinical Meeting to discuss parenteral nutrition compounding practices.

Speaking from both perspectives, Dr. Mark discussed the implementation practices and challenges faced with outsourcing and insourcing parenteral nutrition compounding at Allegheny Health Network hospitals.

Insource versus Outsource

At the time Allegheny initially opted to outsource, they were dealing with staffing challenges, drug shortages (especially electrolyte shortage), and their use of system-wide consultants. After recently moving back to insourcing, they considered regulatory concerns from an outsourcing perspective. They dealt with decreasing drug shortage and cost saving opportunities when they decided to insource.

Program Overview

The Allegheny Health Network hospitals provide an on-site adult neonatal population PN program, with their hospitals using about 8-10 special compounding TPNs per day as well as pre-mixed TPNs. They implemented a hub-and-spoke model along with their home infusion company, which allows them to mitigate the staff and labor challenges and still retain cost savings opportunities. The home infusion company delivers TPNs and pre-mixed TPNs to multiple different sites.

The use of order transmission allows them to electronically submit and manually check orders to maintain a check and balance system, although their recent transition to an interface has further enhanced the process. They also ensure order cut off times to optimize delivery times, and to maintain and efficient process.

Considerations

Hospitals should consider a number of factors when choosing outsourcing or insourcing PN compounding. Staff and labor challenges, drug shortages, TPN annual volumes, and transportation are all important considerations, and hospitals should choose a model that helps optimize efficiency in their PN compounding practices.