Background: The American Society for Parenteral and Enteral Nutrition (ASPEN) parenteral nutrition (PN) safety consensus recommendations advise a comprehensive education program and competency assessment for all healthcare professionals involved in the care of patients receiving PN. The ASPEN-model papers provide guidance for designing PN competencies for prescribers, pharmacists, and pharmacy technicians. The purpose of this research was to evaluate the impact of a comprehensive educational program that aligns with the ASPEN model on PN competency, attitudes, and perceptions in a multidisciplinary healthcare professional audience. Methods: Dietitians, pharmacists, and physicians attended a 3-hour ASPEN model-based educational program focused on PN order writing and review. Matched preeducation and posteducation competency assessments were completed by attendees. Attitudes and perceptions were also assessed before and after the educational program using 5-point Likert scales. Results: Ninety-seven subjects were included in the analysis. The majority of attendees were dietitians (53.6%), followed by pharmacists (45.4%). Overall, multidisciplinary competency assessment scores improved by an average of 12.6% (preassessment average of 62.7%, postassessment average of 75.3%, P < 0.0001). Nine out of 10 statements regarding PN attitudes and perceptions significantly improved on the 5-point Likert scales (P < 0.05). Conclusion: A comprehensive PN educational program in alignment with the ASPEN model positively impacted multidisciplinary healthcare professional PN competency, attitudes, and perceptions. To optimize patient safety, local organizations and institutions should implement formalized training as outlined by the ASPEN model for healthcare professionals involved in the care of patients receiving PN. (Nutr Clin Pract. 2019;34:597-605)

Background The European Society for Clinical Nutrition and Metabolism Guidelines for Parenteral Nutrition in Geriatric Patients state metabolic complications are more frequent in elderly patients. However, literature provides limited information about metabolic complications in older patients receiving parenteral nutrition (PN). Consequently, the purpose of this study was to compare the development of metabolic complications in older vs younger patients receiving PN. Methods Patients receiving PN from May 1, 2014, to February 7, 2017, at Cooper University Hospital were included. Metabolic complications assessed included acid‐base disturbances, hepatic complications, hypercapnia, hyperchloremia, hyperglycemia, hypernatremia, hypertriglyceridemia, hypochloremia, hypoglycemia, hypokalemia, hypophosphatemia, and refeeding syndrome. Results 595 patients were included (older group [≥65 years]: n = 245, median age: 76 years; younger group [<65 years]: n = 350, median age: 53 years]. Certain characteristics were similar between groups (female, 51%; mean body mass index of 28; critically ill, 34%; central PN, 97%; median duration of PN, 7 days; mean energy provision PN, 25.4 kcal/kg/d; mean dextrose infusion rate, 2.31 mg/kg/min). Overall, metabolic complications developed in 58% of patients and occurred more frequently in older vs younger patients (65.7% vs 53.4%; P = .003). Multivariate logistic analysis demonstrated increased odds of metabolic complications in the older group (odds ratio, 1.55; 95% CI, 1.014–2.375). Conclusions Older hospitalized patients are more likely to develop a metabolic complication during their PN course than younger patients. This study heightens awareness that patients of advanced age are subject to metabolic complications; practitioners should anticipate and resolve complications in a timely manner.

Hospitalized adult patients with a baseline CCWCPN were more likely to develop a metabolic complication when receiving PN. Baseline hypernatremia and hyperchloremia were associated with the development of metabolic complications. Baseline CCWCPN should be recognized upon initiation of PN; practitioners should closely monitor patients to minimize subsequent metabolic complications.

No abstract