title: Impact of parenteral nutrition standardization on costs and quality in adult patients.
abstract: BACKGROUND
  Parenteral nutrition (PN) is a costly therapy that can also be associated with serious complications. Therefore, efforts are focusing on reducing rate of complications, and costs related to PN.
  
  
  OBJECTIVE
  The aim was to analyze the effect of the implementation of PN standardization on costs and quality criteria. Secondary aim was to assess the use of individualized PN based on patient's clinical condition.
  
  
  METHODS
  We compare the use of PN before and after the implementation of PN standardization. Demographic, clinical and PN characteristics were collected. Costs analysis was performed to study the costs associated to the two different periods. Quality criteria included were: 1) PN administration; 2) nutrition assessment (energy intake between 20-35 kcal/kg/day; protein contribution according to nitrogen balance); 3) safety and complications (hyperglycemia, hypertriglyceridemia, hepatic complications, catheter-related infection); 4) global efficacy (as serum albumin increase). Chi-square test was used to compare percentages; logistic regression analysis was performed to evaluate the use of customized PN.
  
  
  RESULTS
  296 patients were included with a total of 3,167 PN compounded. During the first period standardized PN use was 47.5% vs 85.7% within the second period (p < 0.05). No differences were found in the quality criteria tested. Use of individualized PN was related to critical care patients, hypertriglyceridemia, renal damage, and long-term PN. Mean costs of the PN decreased a 19.5%. Annual costs savings would be € 86,700.
  
  
  CONCLUSIONS
  The use of customized or standard PN has shown to be efficient and flexible to specific demands; however customized PN was significantly more expensive.
authors.affiliation: Servicio de Farmacia. Hospital Vall Hebron. Barcelona. España.. dberlana@gmail.com.
authors.forename: David
authors.initials: D
authors.lastname: Berlana
authors.affiliation: Servicio de Farmacia. Hospital Vall Hebron. Barcelona. España..
authors.forename: Anna
authors.initials: A
authors.lastname: Barraquer
authors.affiliation: Servicio de Farmacia. Hospital Vall Hebron. Barcelona. España..
authors.forename: Pilar
authors.initials: P
authors.lastname: Sabin
authors.affiliation: Unidad de Soporte Nutricional. Hospital Vall Hebron. Barcelona. España..
authors.forename: Luisa
authors.initials: L
authors.lastname: Chicharro
authors.affiliation: Servicio de Medicina Intensiva. Hospital Vall Hebron. Barcelona. España..
authors.forename: Agueda
authors.initials: A
authors.lastname: Pérez
authors.affiliation: Unidad de Soporte Nutricional. Hospital Vall Hebron. Barcelona. España..
authors.forename: Carolina
authors.initials: C
authors.lastname: Puiggrós
authors.affiliation: Unidad de Soporte Nutricional. Hospital Vall Hebron. Barcelona. España..
authors.forename: Rosa
authors.initials: R
authors.lastname: Burgos
authors.affiliation: Servicio de Farmacia. Hospital Vall Hebron. Barcelona. España..
authors.forename: Julio
authors.initials: J
authors.lastname: Martínez-Cutillas
mesh_terms: D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010288:Parenteral Nutrition / Q000191:economics* / Q000592:standards*; D011787:Quality of Health Care; D012189:Retrospective Studies