Revising the Enteral Formulary to Optimize Nutritional Care at Minimum Cost

Abstract

In this era of health care reform, cost-containment and, ultimately, hospital cutbacks, dietitians must take a proactive stance to minimize hospital costs versus waiting for hospital administration to mandate cutbacks. In this facility the clinical nutrition staff took it upon themselves to revise the enteral formulary as a cost-containment measure. Initially, the hospital pharmacy and nutrition departments stocked approximately 17 enteral products which cost the hospital nearly $45,000.00 in the six-month period spanning January until June of 1994. The first step was to thoroughly review the scientific literature for justification to retain, add or delete products. This information was compiled into a detailed proposal justifying a decrease in the formulary to seven products. Nutrition support dietitians and pharmacists across the state were interviewed to determine the composition of their various formularies. This information was compiled into chart form to facilitate evaluation of the data and simplify comparison to the proposed formulary changes. Utilizing the proposed formulary while keeping total kilocalories and protein constant, estimated costs for six months totalled only $24,000.00, for a savings of $42,000.00 per year. This information was presented to the hospital's Pharmacy and Therapeutics Committee and met with quick approval and praise from administrators and physicians. It is imperative that dietitians be proactive in pursuing cost containment while assuring patients receive optimal nutritional care.