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:
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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