Quality and safety impact on the provision of parenteral nutrition through introduction of a nutrition support team

• Published in: European journal of clinical nutrition 2014-12, Vol.68 (12), p.1294-1299
• Main Authors: Hvas, C L, Farrer, K, Donaldson, E, Blackett, B, Lloyd, H, Forde, C, Garside, G, Paine, P, Lal, S
• Format: Article
• Language: English
• Subjects: 692/699/1702/295; 692/700/565/2072; Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Care and treatment; Catheters; Chi-Square Distribution; Clinical Nutrition; Emergency and intensive care: metabolism and nutrition disorders. Enteral and parenteral nutrition; Enteral feeding; Enteral nutrition; Epidemiology; Feeding. Feeding behavior; Fundamental and applied biological sciences. Psychology; Humans; Intensive care medicine; Internal Medicine; Malnutrition; Malnutrition - mortality; Malnutrition - therapy; Medical instruments; Medical sciences; Medicine; Medicine & Public Health; Metabolic Diseases; Methods; Middle Aged; Nutrition; Nutrition research; original-article; Parenteral feeding; Parenteral nutrition; Parenteral Nutrition - adverse effects; Parenteral Nutrition - methods; Parenteral Nutrition - standards; Parenteral therapy; Patient safety; Patients; Prospective Studies; Public Health; Quality control; Quality of care; Referral and Consultation; Safety; Sepsis - etiology; Support personnel; Teams; United Kingdom; Vertebrates: anatomy and physiology, studies on body, several organs or systems
• ISSN: 0954-3007; 1476-5640
• DOI: 10.1038/ejcn.2014.186

Background/Objectives: Parenteral nutrition (PN) should be provided to the malnourished patient if enteral feeding is insufficient or unsafe. A nutrition support team (NST) may improve PN services. We compared the use and complications of hospital PN before and after the implementation of an NST. Subjects/Methods: All inpatients referred for PN outside of the intensive care unit and the intestinal failure unit were prospectively included from 2009 to 2012. The NST was introduced in 2010. Quality improvement methodology was applied. Results: In 2009, a mean of 16 (limits of normal variation 4–28) patients were referred for PN each month. After introduction of the NST, this rose to 26 (10–42) referrals per month. The percentage of referrals where PN was not initiated increased from 5.3% in 2009 to 10.1% in 2012 ( P =0.03). This increase was restricted to teams that infrequently referred for PN, and enteral nutrition could replace PN in 31 of 51 patients (61%) as compared with 8 of 32 (25%) patients referred from teams that frequently referred for PN ( P =0.001). The frequency of PN started owing to an insufficient oral or enteral intake decreased from 11% to 3% ( P =0.01). The catheter-related bloodstream infection rate dropped from 6.7 to 0.7 episodes per 1000 catheter days ( P