Fiscal impact of a total nutrient admixture program at a pediatric hospital

The financial impact of a total nutrient admixture (TNA) program at a 201-bed pediatric hospital was evaluated, and operational and clinical benefits of the program were identified. Data were collected over 60 days to determine the average number of patients receiving TNAs per day. Daily acquisition costs for equipment and solutions for the TNA system were subtracted from the costs that would have resulted from the delivery of TPN and fat emulsion by separate infusions. The average number of TNAs dispensed daily was multiplied by the time involved in preparing and administering the two delivery systems to determine the impact on daily personnel costs. Based on an average of 20 patients receiving TNA therapy daily, the daily costs for equipment and solutions for preparation of TNAs, as well as the daily equipment costs for TNA administration, were less than those for the administration of separate solutions. Nursing time for the administration of TNAs versus separate solutions was reduced, while pharmacy time associated with the preparation and delivery of solutions increased slightly with the TNA program. This increase was attributed to more time spent by pharmacists on compatibility screening with the TNA program. The estimated total daily cost savings with the TNA program was calculated as $515 for 20 patients. Clinical advantages of the TNA system included improving tolerance and use of fat by administration of emulsion over 24 hours; providing the patient's daily parenteral nutrient needs in a more concentrated source; and reducing the risk of touch contamination and sepsis, based on decreased manipulation of i.v. administration equipment.(ABSTRACT TRUNCATED AT 250 WORDS)