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Application of quality improvement techniques to reduce parenteral nutrition wastage in a national intestinal failure unit
  1. Philip J. Allan1,2,
  2. Michael Taylor1,
  3. Lindsay Harper1,
  4. Amrutha Ramu1,2,
  5. Claire Guest1,
  6. Charlotte Harris3,
  7. Simon Lal1
  1. 1Intestinal Failure Unit, Salford Royal NHS Foundation Trust, Stott Lane, Salford, UK
  2. 2Translational Gastroenterology Unit, Oxford University Hospitals NHS Trust, Headley Way, Oxford, Oxford, UK
  3. 3Department of Pharmacy, Oxford University Hospitals NHS Trust, Headley Way, Oxford, UK
  1. Correspondence to Philip J. Allan, Intestinal Failure Unit, Salford Royal NHS Foundation Trust, Stott Lane, Salford, M6 8HD, UK; philip.allan{at}ouh.nhs.uk

Abstract

Objectives Parenteral nutrition (PN) costs approximately £80 per day per bag. Unpredictable changes in patients’ clinical condition, venous access loss or reasons related to the processes involved in administering PN can lead to PN wastage. Cost efficiencies are imperative to optimise limited resource utilisation in all current healthcare economies. We undertook a quality improvement (QI) project to reduce PN wastage in an adult acute hospital setting. The project SMART's (specific, measurable, achievable, realistic, time-based) objective was reducing in-patient PN wastage by 10% in 9 months using QI methodology on a national intestinal failure unit (IFU).

Method Wastage reasons were evaluated through pareto charts to target waste reduction using ‘Plan, Do, Study, Act’ (PDSA) cycles. Variation was mapped using c-charts.

Results 12-week baseline wastage data predicted 1000 bags wasted per annum (p.a.). PDSA cycles actioned included: regular enhanced clinical team awareness of wastage; unused PN bags redistributed within expiry date; stock bag rotation; critical path analysis of PN bag journey; enhanced discharge planning/coordination; reorganisation of fridge PN storage according to weekday; changing ordering frequency and bag type (from tailored to standard) to increase flexibility around discharge date and PN weaning. Implementation of PDSA cycles led to a 34% reduction in PN wastage in 9 months.

Conclusion In a high-use IFU, PN wastage is common and costly. Using a QI approach with concurrent PDSA cycles and a motivated multidisciplinary team, high levels of wastage reduction are possible with associated significant cost savings and from this study a predicted cost saving of approximately £30 000 p.a.

  • Parenteral Nutrition
  • Quality Improvement
  • Intestinal Failure
  • Wastage
  • Multidisciplinary
  • Plan Do Study Act cycles

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