Centralized insourcing of sterile compounding: One multihospital health system's journey.

Purpose: The process and challenges associated with an initiative to pivot from insourcing the batch compounding of high-volume sterile preparations to insourcing patient-specific compounding of parenteral nutrition (PN) at a health-system central fill pharmacy (CFP) serving 8 hospitals in central Florida are described.

Summary: The insourcing initiative was prompted by a need for greater oversight of sterile compounding to ensure patient safety and the potential for cost savings. In 2014 the health system opened a CFP to provide replenishment of automated dispensing machines and insourcing of 19 compounded sterile preparations (CSPs) as the hub of a hub-and-spoke distribution system for 8 local hospitals. The need to comply with a 2016 proposed Food and Drug Administration requirement limiting the distribution by 503A pharmacies of non-patient-specific CSPs beyond 1 mile and the state of Florida's scope of practice definition related to sterile compounding prompted the CFP to switch from CSP insourcing to PN insourcing. The business case was based on substantial projected cost savings of more than $900,000 annually from PN insourcing versus outsourcing. A hybrid model for insourcing PN preparation was developed by using the PN compounding device, solutions, and additives from different vendors. Standardization of PN formulations and order templates streamlined the ordering process and reduced the unnecessary use of additives and associated costs.

Conclusion: With careful planning, the CFP successfully pivoted from insourcing CSPs to insourcing PN. A collaborative approach with early and frequent communication among key health-system and vendor stakeholders was vital to the success of the initiative.