TPN Center to provide for multiple hospitals

[Levi Anderson]

I would like to seek your opinion whether the option of constructing a central TPN center feeding 3 tertiary Hospitals in different locations would be acceptable? considering the challenges of transporting the prepared TPN.

[Judy Cooper]

Pros of the center:

– Reduce the cost by reducing the consumables, machines, pharmacist working hours, and wasting of materials. Also the net cost will be divided on the 3 hospitals budget, which might help you constructing a far bigger place with plenty of machines and workers.

– You will benefit much from compounding automation which is speedy and easier, because you will have a big number of preparations daily. Manual compounding will not be possible.

– Reduce the number of working trained pharmacists.

– You may be able to do batching and standardized TPN for all the hospitals.

Cons:

– You will have a challenge of transporting the preparation NOT TPN, because TPN can be ordered at specific times and delivered at specific times without a problem. The challenge is when you want to transfer many sterile preparations many times daily for many patients. Some of preparations are in syringe form.!!

– You will NOT be able to prepare STAT medications because of the time consumed in transportation. But this can be solved by putting a LAF workbench at a segregated room at your pharmacy (or satellite pharmacies) with BUD 12 hours.

– You still need trained BCNSP with clinical experience at wards for the clinical issues related to TPN prescribing, and approvals.

– Finally and the most importantly, if you have any error or infection at that center, you will propagate it into 3 tertiary hospitals, can you imagine the size of consequences? This may be overcome by sharp and strict quality assurance measures but still errors happen!

I hope I have helped you taking your decision.

Regards,

[Lillian Gonzalez]

I agree completely with what was said before. I wanted to highlight the specific challenge of running a center that creates TPN.

In the US there is a lot of discussion regarding compounding centers because they are extremely risky. Centers that focus on TPN have also had examples of quality control problems that led to many patient deaths. I absolutely understand all of the advantages, but you will need someone with expertise to create the facility and be focused on the continuous quality control and training of the staff that will run the facility. It’s certainly possible to accomplish this, but there are many, many risks to creating such a center.

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