Parenteral Nutrition Drug Shortages: A Single‐Center Experience With Rapid Process Change

Abstract

Disruptions in the medication supply chain and consequent drug product shortages, including shortages of parenteral products used for parenteral nutrition (PN) compounding, have become an increasingly common occurrence. The amino acid solution shortage that resulted from the devastating impact of Hurricanes Maria and Irma on manufacturing facilities in Puerto Rico in 2017 necessitated a rapid, coordinated shift from use of compounded PN to commercial multichamber‐bag PN (MCB‐PN) at our hospitals. We describe our experience operationalizing this intervention via a framework that may be adapted for addressing other drug product shortages to promote rapid yet safe use of therapeutic alternatives.

Expert consensus statements and summary of proceedings from the International Safety and Quality of Parenteral Nutrition Summit

“…One practical example for dealing with single amino acid solution shortages in one institution was shifting from compounded PN to MCBs whenever possible, which resulted in a 75% reduction in use of these amino acid solutions. 44 Likewise, a recent editorial has addressed how to deal with micronutrient product shortages from a European perspective, 45 and in the UK a British Intestinal Failure Alliance position statement has also addressed this issue. 46 Principles to address PN shortages are summarized in consensus statement 12 ( Table 1 ).…”

Safety in parenteral nutrition compounding

“…This escalation can be attributed to facilities reducing the number of products compounded and recent medication shortages of PN components. 25,26 Currently, in the United States, MCB-PN products are available as two-chamber and three-chamber bags. 27,28 These products require less manipulation and admixing and are often not considered as complex as compounded PN.…”

“…The use of commercially available multichamber bag PN (MCB‐PN), formerly known as premixed PN, 21 has increased in the United States. This escalation can be attributed to facilities reducing the number of products compounded and recent medication shortages of PN components 25,26 . Currently, in the United States, MCB‐PN products are available as two‐chamber and three‐chamber bags 27,28 .…”

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

“…2 In an era when supply chain disruptions are becoming more common and shortages of parenteral products used for PN compounding occur more frequently, commercial 3CBs are gaining widespread use in the US. 3 Thus, it is imperative that pharmacists become familiar with all available PN products to implement safe and effective therapeutic alternatives when traditional HCBs are unavailable for use.…”

“…Compared with HCBs, 3CBs require fewer preparation steps and less manipulation and may offer potential advantages such as decreased compounding time, lower labor costs, and reduced risk of medication errors 2 . In an era when supply chain disruptions are becoming more common and shortages of parenteral products used for PN compounding occur more frequently, commercial 3CBs are gaining widespread use in the US 3 . Thus, it is imperative that pharmacists become familiar with all available PN products to implement safe and effective therapeutic alternatives when traditional HCBs are unavailable for use.…”