P644 - THE HIDDEN COST OF ONE-SIZE-FITS-ALL PARENTERAL NUTRITION: A WASTEFUL PRACTICE IN HOSPITALIZED PATIENTS

P644

THE HIDDEN COST OF ONE-SIZE-FITS-ALL PARENTERAL NUTRITION: A WASTEFUL PRACTICE IN HOSPITALIZED PATIENTS

T. Tabone^1,*

¹Mater Dei Hospital, Msida, Malta

 

Rationale:  

At Mater Dei Hospital, Malta, only a single 2L multi-chamber bag (MCB) containing 2280 kcal, 14g nitrogen, and fixed electrolytes is available for parenteral nutrition (PN). Due to individualized patient needs, partial MCB administration leads to significant waste. This study quantified the financial and product loss associated with this practice and assessed the cost-effectiveness of introducing MCBs with varied volumes and macronutrient compositions.

Methods: A retrospective analysis was conducted on all inpatients prescribed PN at Mater Dei Hospital over 6 months (September 2023 to March 2024). The financial cost and waste implications of using the available 2L MCB versus potential 1L and 1.5L MCB options were assessed. Financial cost calculations were based on the unit cost of each formulation. 

Results: A total of 31 patients received PN, with an average feeding duration of 15.8 days per patient, totaling 491 PN days. The current practice of using the 2L MCB resulted in the following cost and waste estimates:

        - Total cost using only 2L MCB: €17,234 (491 days, €35.10 per 2L MCB)

        - Days where ≤1L was prescribed: 81

            - If 1L MCB used (€25.35) = €2,053 and avoided 81L PN discard.

        - Days where 1.5L was prescribed: 237

            - If 1.5L MCB used (€29.90) = €7,086 and avoided 119L PN discard.

        - Days where 2L was fully utilized: 173 (€6,072 total cost).

If 1L and 1.5L MCBs had been available, the total cost would have been €15,211, yielding a potential cost saving of €2,023 over 6 months and €4,046 over 1 year, while preventing the discard of 200L and 400L of MCB, respectively.

Additionally, incomplete micronutrient provision occured in 318 of 491 PN days (64.8%) due to partial MCB use.

Conclusion: The restriction to a single MCB formulation resulted in significant financial waste and unnecessary product disposal. The availability of multiple MCB formulations could improve cost-effectiveness and resource utilization.

Disclosure of Interest: None declared