Savings achieved through use of a less concentrated amino acid solution

The administrative process of adding a 5.5% crystalline amino acid solution to the formulary of two affiliated hospitals and the results of the addition are discussed. A formulary change was sought after it was found that many patients on parenteral nutrient therapy were receiving more amino acids than they needed. Nearly all patients on parenteral nutrient therapy were receiving 8.5% crystalline amino acid solution. The approach to achieving the pharmacy and therapeutics committee's approval of the formulary change included documenting amino acid needs from the literature, securing a multidisciplinary base of support and providing economic impact information. A standard TPN order form for physicians, education through the pharmacy newsletter, and presentations at surgery and medical conferences and grand rounds were implemented to assure that the change was effective. During the 12 months following approval of the formulary addition, 66% of the more than 20,000 total parenteral nutrient solutions were prepared using 5.5% amino acid solutions. This resulted in an annual savings of $41,028