Among the many long-standing challenges faced by hospital pharmacies are the ordering, acquisition, storage, and administration of parenteral nutrition (PN), particularly in vulnerable patient populations. Beginning with the overarching decision of whether to outsource PN products or compound them in-house, several permutations quickly arise, much like a chess match unfolding. Key decision points include turnaround time for PN, specifically, and the impact on pharmacy staff members’ ability to compound other, patient-specific medications. Moreover, staff resources in general are affected by the initial choice, as is a pharmacy’s compliance program for USP <797>.
Further occluding the decision are the various patient populations a pharmacy attends to, such as those with refeeding syndrome, a complex issue covered herein. And as mentioned, vulnerable patients including pediatrics and neo-nates require additional PN considerations, a topic also covered in this month’s supplement.
The fact remains that a steady, safe, and reliable supply of PN is a necessary component for positive patient outcomes. Fortunately, numerous resources are available to help pharmacy directors seize control of this important process. Whether the pharmacy partners with an established outsourcer or decides to acquire the equipment and skill sets to produce PN in house, parenteral nutrition will remain a stalwart of pharmacy practice moving forward.
If you have unique or novel methods of managing your PN supply, we would love to hear about it.
All the best,
R. Mitchell Halvorsen