PT  - JOURNAL ARTICLE
AU  - Philip J Allan
AU  - Michael Taylor
AU  - Lindsay Harper
AU  - Amrutha Ramu
AU  - Claire Guest
AU  - Charlotte Harris
AU  - Simon Lal
TI  - Application of quality improvement techniques to reduce parenteral nutrition wastage in a national intestinal failure unit
AID  - 10.1136/ejhpharm-2016-001197
DP  - 2018 Mar 01
TA  - European Journal of Hospital Pharmacy
PG  - 85--91
VI  - 25
IP  - 2
4099  - http://ejhp.bmj.com/content/25/2/85.short
4100  - http://ejhp.bmj.com/content/25/2/85.full
SO  - Eur J Hosp Pharm2018 Mar 01; 25
AB  - 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.