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At a specialist paediatric centre, Solivito-N is the sole water-soluble vitamin product used in bespoke and standard parenteral nutrition (PN). In October 2023, there was a global shortage of Solivito-N. Contracted PN suppliers started allocating 50% of usual allowance of Solivito-N for bespoke PN compounding and lipid syringe batch production. Consequently, supplies were depleting rapidly, and the Nutrition Support and Intestinal Failure Team (NSIFT) were forced to evaluate how water-soluble vitamins were prescribed for PN patients. Alternative intravenous and enteral options for water soluble vitamins were assessed; other Trusts/suppliers were also consulted. A comparison of products was completed against guidelines, including a risk assessment of combination products versus current products used and on the Trust formulary. Actions required for PN patients were mapped out by NSIFT. Considerations included monitoring of water-soluble vitamin blood levels, frequency of patient reviews to ensure appropriate prescribing and management of bespoke versus standard PN to preserve stock. A decision pathway was created (see image 1) and approved by all stakeholders and governance. Updates were sent to all clinical areas. The notification letter was formulated and approved for dissemination to parents/carers for PN patients.An audit was conducted for four months, including total 89 PN patients, to record the Solivito-N decisions and to document the bloods results of vitamin B12 and folate monitoring. As vitamin C levels could not be monitored, high risk patients were prioritised for full dose.Analysis from the audit highlighted that the actions implemented in response to the Solivito-N shortage were appropriate. The monitoring frequency allowed changes to be made to the vitamins provision efficiently and effectively, whilst working within the allocation of Solivito-N. NSIFT reviewed patients more frequently to ensure appropriate PN prescribing, and t he status of the shortage was discussed at the weekly NSIFT grand round meetings.Abstract OC77 Image 1