Cost, Time, and Error Assessment During Preparation of Parenteral Nutrition: Multichamber Bags Versus Hospital‐Compounded Bags

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Background The 2018 Lipids in Parenteral Nutrition summit involved a panel of experts in clinical nutrition, lipid metabolism, and pharmacology, to assess the current state of knowledge and develop expert consensus statements regarding the use of intravenous lipid emulsions in various patient populations and clinical settings. The main purpose of the consensus statements is to assist healthcare professionals by providing practical guidance on common clinical questions related to the provision of lipid emulsions as part of parenteral nutrition (PN). Methods The summit was designed to allow interactive discussion and consensus development. The resulting consensus statements represent the collective opinion of the members of the expert panel, which was informed and supported by scientific evidence and clinical experience. Results The current article summarizes the key discussion topics from the summit and provides a set of consensus statements designed to complement existing evidence‐based guidelines. Lipid emulsions are a major component of PN, serving as a condensed source of energy and essential fatty acids. In addition, lipids modulate a variety of biologic functions, including inflammatory and immune responses, coagulation, and cell signaling. A growing body of evidence suggests that lipid emulsions containing ω‐3 fatty acids from fish oil confer important clinical benefits via suppression of inflammatory mediators and activation of pathways involved in the resolution of inflammation. Conclusions This article provides a set of expert consensus statements to complement formal PN guideline recommendations.

Section: Practical Handling Aspectsmentioning

confidence: 99%

Summary of Proceedings and Expert Consensus Statements From the International Summit “Lipids in Parenteral Nutrition”

Martindale

Berlana

Boullata

et al. 2020

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“…Although multi‐bottle or 2‐in‐1 PN systems are used when stability concerns exist, TNA (whether commercial MCBs or custom compounded) reduces manipulations and resultant risk of infection and lowers costs compared with multi‐bottle PN systems . Among other advantages, commercial MCB products are also associated with fewer errors …”

Section: Ile Preparationmentioning

confidence: 99%

“…MCBs have certain advantages over hospital‐compounded PN such as a longer shelf life, manufacturer‐guaranteed stability, easy traceability, and clinical advantages mentioned previously . Moreover, standardization with MCBs appears to offer significant cost savings and reduced preparation time over compounding, as well as a reduction in errors related to PN preparation …”

Section: Standardization Of Pnmentioning

confidence: 99%

“…29 Among other advantages, commercial MCB products are also associated with fewer errors. 30 Although the use of an automated compounding device to prepare PN admixtures from multiple component products generally precludes in-process filtration, this practice can be incorporated as indicated during compounding. 31 This could help reduce the particulate load from extrinsic and intrinsic contamination.…”

Section: Ile Preparationmentioning

confidence: 99%

“…20,72 Standardization using MCBs has advantages over compounded bags and multi-bottle systems, including shorter length of hospitalization, reduced time and labor, and fewer errors in PN preparation. 29,30 However, standard PN formulations cannot always cover the macronutrient needs of all patients (eg, some patients with renal impairment, critical illness, and those undergoing long-term PN). 72 Of particular note is the use of MCBs after surgery, as surgical patients account for a large proportion of patients requiring PN.…”

Section: Standardization Of Pnmentioning

confidence: 99%

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Use of Intravenous Lipid Emulsions With Parenteral Nutrition: Practical Handling Aspects

Boullata

Berlana

Piętka³

et al. 2020

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A number of topics important to the handling of intravenous lipid emulsions (ILEs) were discussed at the international summit. ILE handling includes the preparation and the administration steps in the typical use of parenteral nutrition (PN). The discussion and consensus statements addressed several issues, including standardization of the PN process, use of commercially available multi‐chamber PN or compounded PN bags, the supervision by a pharmacist with expertise, limiting ILE repackaging, and infusion duration.

Multicenter Prospective Evaluation of Parenteral Nutrition Preparation Time and Resource Utilization: 3‐Chamber Bags Compared With Hospital Pharmacy–Compounded Bags

Cogle

Martindale

Ramos³

et al. 2020

Background: Parenteral nutrition (PN) is a complex and costly therapy that places significant demands on healthcare resources. Commercially manufactured 3-chamber bags (3CBs) offer potential time and cost advantages compared with hospital pharmacycompounded bags (HCBs); however, no data are yet available from studies comparing these delivery systems in US hospitals. The primary aim of this study was to evaluate the PN preparation time and resource utilization required for 3CBs compared with HCBs in US hospitals. Methods: A prospective, multicenter, time and motion study was performed to evaluate the time from transcription to completion of PN preparation and costs for 3CBs compared with HCBs. The cost per bag included labor, PN products, medical consumables, and equipment. Results: One hundred thirty-six PN prescriptions were prepared during the study (66 prescriptions for 3CBs and 70 prescriptions for HCBs). The mean ± standard deviation total time required for transcription, review, validation, and preparation of PN was 5.5 ± 1.3 minutes for 3CBs vs 14.3 ± 6.2 minutes for HCBs (P < .001). The mean total cost per PN bag was $81.60 for 3CBs and $131.17 for HCBs (mean difference, −$49.57). Conclusion: Commercial 3CBs reduced staff time by 62% and direct costs by 37% compared with HCBs. The results demonstrate that 3CBs offer potential cost-savings for hospitalized patients who require PN in US hospitals.