Parenteral Nutrition Product Shortages

Abstract

Product (drug) shortages have had a significant impact on the healthcare system, particularly on patients and clinicians. This has been especially true with patients requiring parenteral nutrition (PN). The American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) has dealt with PN product shortages in the past on behalf of its members and their patients. However, the shortage severity and duration have made dealing with the PN product shortages in 2010-2012 extremely challenging.

Prescription Drug Shortages: Impact on Neonatal Intensive Care

“…In the NICU, complications have occurred due to a shortage of intravenous selenium which is an additive to parenteral nutrition [16]. The American Society for Parenteral and Enteral Nutrition (ASPEN) issued recommendations regarding the management of parenteral nutrition product shortages during the peak of the 2010–2012 shortage [17]. The ASPEN recommended to use specific pediatric or neonatal products only for these patient groups [18].…”

“…The recommendations of the respective professional society should be followed, such as pediatric societies, the ASPEN, the Children’s Oncology Group, and the ASHP, and in part, mitigation strategies can be adopted from adult recommendations (Table 5) [2, 17, 24-26]. …”

Standardized versus custom parenteral nutrition: Impact on clinical and cost-related outcomes

“…consensus guidelines recommend strategies such as rationing the use of macronutrients and micronutrients in critical shortage. 10 Substitution with standardized PN formulations is suggested as a potential option for providing PN in shortage situations; however, this alternative is not fully endorsed by A.S.P.E.N. in light of the limited evidence for its efficacy and safety.…”

Drug Shortages and Patient Safety

“…suggests consideration of using oral or enteral administration, elimination of adding injectable electrolytes to enteral nutrition products, and prioritization of patients to save supplies for those most vulnerable. 7 Antimicrobial stewardship programs provide an additional route for conserving limited supplies of antiinfective medications. 19 The Working Group on Chemotherapy Drug Shortages in Pediatric Oncology recommends maximizing the potential benefits of effective drugs and ensuring equitable access among patients, using methods such as optimizing use of existing supplies, giving equal priority to evidence-based drugs regardless of whether they occur within a clinical trial or not, and institutional sharing of drug supplies.…”