Parenteral Nutrition Waste Reduction Initiative
European Statement
Selection, Procurement and Distribution
Author(s)
Marie O Halloran, Siobhán Nestor
Why was it done?
This project was undertaken in reaction to an evolving healthcare environment. It was important to identify patterns to improve the efficiency of the purchasing and dispensing process, and to ensure that PN levels held in the Pharmacy Department respond to requested use within the hospital. The aim was to reduce the amount of PN bags expiring with associated cost savings and waste avoidance.
What was done?
The Pharmacy Department is responsible for dispensing Parenteral Nutrition (PN) in the Mater Misericordiae University Hospital (MMUH). PN is purchased from a third party manufacturer. On receipt by the hospital, the standard PN bag has an expiry date of approximately 60 days. Given the need for rapid turnover of PN to avoid expiration and wastage, coupled with the rapidly changing healthcare landscape, the pharmacy instigated a review of the factors contributing to PN waste and opportunities to improve and optimise the associated processes.
How was it done?
• PN Stock Holding Review
Due to surgery volumes and the complexity of the patient cohort in MMUH, the Pharmacy Department are required to hold a stock of PN bags for patients to access in a timely manner. The agreed levels of stock held was identified as a key target to reduce waste. The quantity of each stock bag held was reviewed between Pharmacy and Clinical Dietetics utilising recent usage pattern reports. This resulted in removing certain bags from MMUH stock entirely and reducing the stock quantity of slow-moving bags.
• Improved communication to dietitians
A standard email template was devised to send to all stakeholders, by a Dispensary Pharmacist, detailing the stock of each bag on hand and highlighting bags which would expire in the following two weeks. The Dietitians endeavour to utilise this short-dated stock for suitable patients to avoid waste.
What has been achieved?
Through the improvement initiatives outlined above, PN waste reduced by 74% (117 bags versus 31 bags) in Q1-Q3 2021, compared to the same period in 2020. This resulted in a considerable associated cost saving.
What next?
We will continue our collaborative work with Clinical Dietetics to further reduce PN waste. We now have a dynamic stock management process, which responds to the changing patient cohort in MMUH.