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Audit of pharmacy TPN services on the neonatal intensive care unit (NICU)
  1. S Rohimun,
  2. N Nakrani
  1. The Whittington Hospital NHS Trust, London, UK


Objective At The Whittington Hospital, pharmacy is responsible for providing a total parenteral nutrition (TPN) service to neonatal intensive care unit (NICU). The aims are to deliver a safe and beneficial service to patients, which is also cost-effective to the Trust. Neonatal TPN bags are manufactured off-site, and there are two main types of bag procured: Standard Stock Bags and Tailor-Made Bags. This audit was designed to investigate the management and delivery of TPN to NICU in the Trust over a 12-week period, focusing on the type of bag prescribed, usage and the expenditure. This in turn helped to determine new local standards of management with the aim of optimising the TPN service, with reduced costs and wastage.

Methods Data was collected over 12-weeks (19 October 2009 to 8 January 2010) and expenditure calculated with pricing adapted from JAC and the Service Level Agreement held with external suppliers.

Results Table 1 summarises the types and cost of bag used over the audit period and the number of which incurred wastage.

Table 1

Summary of TPN usage and cost

Where there were differences in the TPN prescription compared to the standard formula, tailor-made bags were ordered. Table 2 summarises the main changes made.

Table 2

Summary of change made to tailor-made bag

Conclusion Findings from the audit showed a high usage of tailor-made TPN compared to stock TPN, most of which were bespoke bags (bags with additions made to the standard stock formula). Since conducting the audit practice has been reviewed: a new stock order level has been put in place, in addition a new TPN prescription has been developed, which helps distinguish between the different bags available. Although TPN requirements are based on the individual patient, the audit suggests that the stock bag may need to be reviewed for a more favourable alternative (and in-line with the latest ESPGHAN recommendations). A re-audit is intended, where it is hoped that optimised management of the pharmacy TPN service to NICU will be demonstrated.

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