Weigh the Benefits of Outsourcing Versus Compounding Parenteral Nutrition (PN) In-House.
To make an informed decision regarding outsourcing PN versus compounding in-house, begin with the ASHP Guidance on Outsourcing Sterile Compounding Services, available at: http://www.ashp.org/Outsourcing-Compounding-Services, which is required reading for any organization considering outsourcing PN. The guidance describes the services provided by vendors of outsourced sterile compounding services, the environmental influences affecting outsourcing decisions, the purposes and process of outsourcing, and steps for evaluating a contractor’s performance.
The most significant factors affecting an organization’s decision should include the regulatory and quality assurance requirements for compounding in-house; the physical space and facilities requirements; staffing concerns; staff training, education, and maintaining competency requirements; efficiency; and cost-effectiveness. Each organization must answer these questions: Do we have the ability to meet the regulatory and sterile compounding requirements? Do we have the required physical space and facilities to compound PN in-house? Moreover, an organization must consider if compounding in-house is the most effective use of pharmacist and technician time—in other words, does it make sense from an overall efficiency and cost standpoint? Outsourcing allows staff to be redeployed to perform other patient care functions. Careful consideration of these factors should be key to deciding whether outsourcing PN fits into an organization’s overall compounding strategy.
Some hospitals have realized valuable benefits to outsourcing PN, including the following:
- Peace of Mind. With proper research, organizations that outsource PN can have confidence that the vendor meets regulatory requirements and has good quality assurance measures in place.
- No Need to Renovate. If an organization does not have the facilities required to compound PN in-house, outsourcing maybe an effective option for sourcing PN. In addition, consider that changing USP requirements could require a major physical overhaul to ensure compliant compounding.
- Efficiency and Cost-Effectiveness. Compared with compounding PN in-house, a compounding pharmacy may be able to produce PN more efficiently, and possibly at a lower cost. An outsourced compounder has the infrastructure in place to create efficiencies of scale in the overall compounding process. In addition, in-house efficiency is maintained as pharmacists and technicians can be redeployed to patient care activities.
- Medication Safety. Outsourcing pharmacies compound multiple PNs on a daily basis, whereas a hospital organization may compound PN only sporadically. There is more room for error when a task is performed intermittently rather than consistently. Moreover, when an organization compounds PN sporadically, it is critical to maintain education and staff competencies, which requires time and dedicated resources.
- Mitigate the Impact of Medication Shortages. Significant PN drug shortages have occurred in the past, although they have somewhat diminished as of late. At the peak of PN shortages, outsourcing can allow access to PNs that a hospital may not been able to obtain on its own. As a high-volume consumer of these medications, an outsourcer may be able to obtain these medications in sufficient quantities.
- Outsourcing Improves Standardization. When utilizing the services of an outsourced PN vendor, the template, ordering process, review process, delivery process, and hang time are standardized. Standardizing the process to the greatest possible extent is key to safe use.
- Outsourcing Enables Redeployment of Staff. Outsourcing PN may increase the amount of time staff can focus on patient care, rather than compounding and reviewing PN.
Perform Due Diligence When Choosing a Vendor.
When choosing a PN vendor, consider the vendors’ reputations, network with colleagues who use outsourced PN to gain their insight, and evaluate which products each vendor can provide. For example, if your patient population requires a large volume of patient-specific PNs, this will be an important consideration in choosing a vendor. In addition, some vendors can provide additional services beyond PN. Moreover, consider the available contracting options each vendor offers. Of course, seek a vendor that deploys the appropriate safety checks to ensure medication safety.
Take advantage of the ASHP Foundation’s Outsourcing Sterile Products Preparation Contractor Assessment Tool, which assists in evaluating regulatory compliance, quality and patient safety measures, medication administration safety features, and service excellence of parenteral product preparation services (available at: http://www.ashpfoundation.org/sterileproductstool).
Finally, visit the facility to get a firsthand view of its operation and practices. While a site visit cannot elucidate a comprehensive view of a PN vendor, it can provide a snapshot of its medication safety practices at one point in time.
Jennifer Karpinski is a senior editor at Pharmacy Purchasing & Products magazine and can be reached at firstname.lastname@example.org.
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