title: Use of Premixed Parenteral Nutrition During a Phosphate Shortage in a Non-Critically Ill Population.
abstract: BACKGROUND
  Drug shortages pose prescribing problems to clinicians. During fiscal year (FY) 2014, an acute shortage of intravenous potassium phosphate (K-Phos IV), a common supplement in parenteral nutrition (PN), prompted the use of premixed instead of individualized PN to conserve K-Phos IV. Here we quantify the K-Phos IV conserved by using premixed PN and the associated cost differences.
  
  
  METHODS
  Costs of preparing premixed PN vs individualized PN of equivalent composition were calculated for FY 2014 at a single-center tertiary care facility. Quantity and cost of K-Phos IV saved were calculated based on the number of premixed PN prescriptions. Costs for FY 2015 were projected based on drug costs from July 2014.
  
  
  RESULTS
  During FY 2014, prescribing premixed in lieu of individualized PN conserved 16,440 mmol K-Phos IV but increased the cost of PN by $4080.45. However, increases in K-Phos IV cost at the end of FY 2014 resulted in premixed PN as a relatively less expensive therapy than individualized PN for our institution. Cost savings of $7092.20 due to use of premixed PN is projected for FY 2015.
  
  
  CONCLUSIONS
  Prescribing premixed PN conserves K-Phos IV during shortages, but it increased direct drug spending in non-critically ill patients at our institution during FY 2014. Persistent shortages can drive market costs of K-Phos IV, however, necessitating frequent reconsideration of resource utilization.
authors.affiliation: Department of Pharmacy, University of Wisconsin Hospital and Clinics, Madison, Wisconsin, USA.
authors.forename: Caitlin S
authors.initials: CS
authors.lastname: Curtis
authors.affiliation: Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.
authors.forename: Rebecca A
authors.initials: RA
authors.lastname: Busch
authors.affiliation: University of Wisconsin-Madison School of Pharmacy, Madison, Wisconsin, USA.
authors.forename: Ryan L
authors.initials: RL
authors.lastname: Crass
authors.affiliation: Department of Pharmacy, University of Wisconsin Hospital and Clinics, Madison, Wisconsin, USA.
authors.forename: Aaron P
authors.initials: AP
authors.lastname: Webb
authors.affiliation: Veteran Administration Surgical Service, William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin, USA Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA kudsk@surgery.wisc.edu.
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: Kudsk
mesh_terms: D061605:Administration, Intravenous; D006801:Humans; D010288:Parenteral Nutrition; D057947:Parenteral Nutrition Solutions / Q000737:chemistry* / Q000191:economics; D004364:Pharmaceutical Preparations / Q000191:economics / Q000600:supply & distribution; D010710:Phosphates / Q000191:economics / Q000600:supply & distribution*; D017680:Potassium Compounds / Q000191:economics / Q000600:supply & distribution*; D012189:Retrospective Studies
chemical_list: D057947:Parenteral Nutrition Solutions; D004364:Pharmaceutical Preparations; D010710:Phosphates; D017680:Potassium Compounds; C013216:potassium phosphate
keywords: dietary phosphorus; nutritional support; parenteral nutrition; phosphates