Enteral formulary management: a cost-effective approach

Although enteral formularies emerged over 30 years ago, their effectiveness remains to be clearly demonstrated. Enteral formulary (EF) development has occurred over 17 years at the Toronto Rehabilitation Institute (Toronto Rehab), and a historical account is available in the literature. At Toronto Rehab, the creative process begins with a review of specific nutrition support requirements for each patient population, which is coupled with a clinical decision-making algorithm to promote standardized clinical nutrition practices and selection of products. The requirements are translated into detailed product specifications for a streamlined array of oral and tube-feeding formulae. Despite outsourced food service systems, the feasibility of simple in-house production should be considered to help curtail overall costs. The promotion of consistent practices requires nutrition support guidelines, including indications and contraindications for each EF product. Competitive bidding practices and policies that scrutinize non-formulary requests and encourage automatic substitution for non-formulary products promote formulary adherence and contain costs. Ongoing evaluation is intended to capture changes in patient populations and product availability to target opportunities for future EF revisions.