Recently, I have looked into the utilization of premix PN (three chamber bag system). Below steps may help in assessing the utilization of premix PN
Assess current PN utilization and patient population by performing utilization review
Retrospective or prospective PN utilization review. (looking at the below criteria)
Age group (Adult, pediatric, neonates)
Central or peripheral PN
Short term or long-term
Number of PN orders per day
You may also asses pros and cons of each customized versus premix
1- Safety: Measured by ADR (Complication)
2- Efficacy: Since there is no single indicator to assess nutritional status. Efficacy can be assessed by comprehensive evaluation of weight, electrolytes level, hydration status, prealbmuin etc.
3- Cost: Direct (Cost of the PN bag customized versus premixed) and indirect (staffing and equipment)
Usually, stable young patients with no co-morbidity will tolerate ready-made PN and it’s a cost saving to the institution. However, if the majority of patient population is pediatric and neonates then customized can’t be replaced by ready-made.