Considerations for the management of home parenteral nutrition during the SARS-CoV-2 pandemic: A position paper from the Home Artificial Nutrition and Chronic Intestinal Failure Special Interest Group of ESPEN

Lal, Simon; Gossum, A. Van; Joly, Francisca; Bozzetti, Federico; Cuerda, Cristina; Lamprecht, Georg; Mundi, Manpreet S.; Staun, Michael; Szczepanek, Kinga; Wanten, Geert; Wheatley, Carolyn; Pironi, Loris

doi:10.1016/j.clnu.2020.05.023

Cited by 9 publications

(14 citation statements)

References 14 publications

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“…Seventeen articles comprising guidelines, consensus, recommendation, and position papers were excluded from the ranking process. [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] An average of 27 articles (range: 15-53) of the 152 from the primary literature were denoted as most important by individual members of the author group. Five papers from the primary literature were collectively identified (receiving 5 or more votes) as most important by the authors.…”

Section: Resultsmentioning

confidence: 99%

Significant Published Articles in 2020 for Pharmacy Nutrition Support Practice

et al. 2021

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Purpose: The purpose of this article is to assist the pharmacist engaged in nutrition support therapy in staying current with pertinent literature. Methods: Several clinical pharmacists engaged in nutrition support therapy compiled a list of articles published in 2020 considered important to their clinical practice. The citation list was compiled into a single spreadsheet where the author participants were asked to assess whether the article was considered important to nutrition support pharmacy practice. A culled list of publications was then identified whereby at least 5 out of the 8 author participants considered the paper to be important. Guideline and consensus papers from professional organizations, important to practice but not ranked, were also included. Results: A total of 169 articles were identified; 5 from the primary literature were voted by the group to be of high importance. An additional 17 guidelines, position, recommendation, or consensus papers were also identified. The top-ranked articles from the primary literature were summarized and a narrative regarding its implications to pharmacy nutrition support practice were provided. Conclusion: We recommend that pharmacists engaged in nutrition support therapy be familiar with these articles as it pertains to their practice.

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Section: Resultsmentioning

confidence: 99%

Significant Published Articles in 2020 for Pharmacy Nutrition Support Practice

et al. 2021

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“…UK study showed that remote solutions can be safely introduced in HPN. Considering the rapid growth of the number of HPN patients it can help with the demand of trained medical staff reducing the need for hospital attendance of patients, traveled miles to maximize the high satisfaction from medical care [17] . Other studies confirm that telehealth may be effective and cost-saving [ 18 , 19 ].…”

Section: Discussionmentioning

confidence: 99%

“…ESPEN recommends self-isolation of HPN patients, protective equipment during visits, the introduction of telemedicine, avoiding face-to-face consultations and limiting blood testing to necessary ones. The need for established strategies for patients’ discharge from the hospital and transfer to the IF unit is underlined [ 17 , 18 ]. Those recommendations are similar to the position paper proposed by the Polish expert group concerning principles of home nutrition during a pandemic [19] .…”

Section: Introductionmentioning

confidence: 99%

Organizational issues of home parenteral nutrition during COVID-19 pandemic: Results from multicenter, nationwide study

et al. 2021

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Objectives Patients on home parenteral nutrition (HPN) are prone to severe complications of SARS-COV-2 infection. The pandemic requires adaptation of the health care standards, including epidemiological surveillance, logistics of home supply and monitoring. Potential lack of medical professionals may worsen the standard of care. The aim of the analysis was to evaluate the medical staff resources in HPN units. Results The study was conducted by major Polish scientific societies in clinical nutrition. A questionnaire was distributed among all Polish adult HPN centers concerning statistics from the first three months of the pandemic (March-May 2020). Data on medical staff resources and organizational issues of the units were collected. Modifications of the home procedures, SARS-CoV-2 infection rates of HPN patients and health care workers (HCW) were analyzed. Influence of the pandemic on the rates of new qualifications for HAN (home artificial nutrition) was estimated. 14 of 17 adult Polish HPN units took part in the study. The point prevalence of HPN in Poland was 30.75 per million citizens. 344 HCW are involved in patients’ care in Polish HPN units; 18.9% are physicians (49%-surgeons, 18.46%-internal medicine specialists, 15.38%-Anesthesiologists, 7.69%-Pediatricians, 1.54%- Palliative care specialists), 32.27% nurses, 5.23% dietitians, 9.01% pharmacists, 4.94% pharmacy technicians, 3.2% pharmacy assistants, 5.81% administrative workers, 3.49% physiotherapists. HAN Patient to HCW ratios for physicians, nurses, pharmacists, dietitians were respectively: 49.5; 29.15; 111.6; 181.6. Medium age of physicians and nurses was: 45.6 and 44.15. 53.8% of physicians and 31.53% of nurses work parallelly in hospital wards. 31 Pharmacists overall are working in all HPN units (2.21 per unit) and 18 dietitians (1.3 per unit). 9 patients had a confirmed COVID-19 infection (4- HPN, 5-HEN). All the units introduced telemedical solutions in the first months of the pandemic. The number of new qualifications for HPN and HEN in the units did not significantly decline in March-May in comparison with a similar period in 2019. Conclusions A shortage of HPN medical professionals requires attention when planning health care organization, especially during a pandemic. Severe restrictions in public health system may not reduce the number of new qualifications for the HPN procedure. There is a need for the continuation of data collection during the evolution of the pandemic as it may have a detrimental impact on HPN including serious issues with access to professional HCW.

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“…Prevention of infection with COVID‐19 is thought to be reduced through mask usage 11 given the risk of airborne viral infections, 12 and masks should therefore be available for all carers, whether home care nurses or relatives. The ready availability of monitoring through biochemical assessments, clinic appointments, pertinent radiological investigations, and access to fully staffed teams are important strategies to protect these vulnerable patients, as recommended by the European Society for Clinical Nutrition and Metabolism (ESPEN) 6,13,14 …”

Section: Introductionmentioning

confidence: 99%

“…The ready availability of monitoring through biochemical assessments, clinic appointments, pertinent radiological investigations, and access to fully staffed teams are important strategies to protect these vulnerable patients, as recommended by the European Society for Clinical Nutrition and Metabolism (ESPEN). 6,13,14 Patients with IF share similar key characteristics with patients who are most at risk for COVID-19. As a population, they are at risk of malnutrition and have comorbidities and, as a population, are getting older: 20%-36% of patients receiving HPN were aged >65-69 years, 10 with ≤20% having multiple comorbidities.…”

Section: Introductionmentioning

confidence: 99%

An International Survey of Clinicians’ Experience Caring for Patients Receiving Home Parenteral Nutrition for Chronic Intestinal Failure During the COVID‐19 Pandemic

Allan

Pironi

Joly

et al. 2020

J Parenter Enteral Nutr

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Background and Aims This survey of centres caring for patients on home parenteral nutrition (HPN) was conducted to assess the impact of the COVID‐19 crisis on the management of these patients in terms of provision of care, monitoring, regular follow‐up and any changes to service infrastructure. Methods A survey was devised and publically published on the REDCap database management system with individual centres responding to a public link. Results 78 adult and paediatric centres worldwide contributed to the survey, representing at least 3500 patients’ experience. Centres (n/78 unless otherwise specified, %) reported infrastructure maintenance for PN bag deliveries to patients (60, 76.92%) or delivery of ancillary items (dressing packs, gloves, bungs) (57, 73.08%) home delivery and HPN administration (65, 83.33%) but homecare nurse shortages (25, 32.05%). Follow up of routine HPN patients changed to either all telemed or mixed with emergency clinic review (70, 89.74%). In 26 centres (33.33%), new discharges on HPN for benign conditions were reduced or stopped. Based on clinical history the centres reported psychological distress for patients (52, 66.67%) with anxiety, worry, concern and apprehension reported most frequently (37/52, 71.15%) but also fear (10/52, 19.23%), depression (5/52, 9.62%) and issues related to isolation/confinement (12/52, 23.08%). Conclusions The COVID‐19 pandemic was reported by clinicians to have had a far reaching adverse impact on patients on home parenteral nutrition, especially their safety in terms of provision of PPE, PN bags, available nursing staff and psychological well‐being. Healthcare systems responded to the challenge presented with new ways of working. This article is protected by copyright. All rights reserved

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Considerations for the management of home parenteral nutrition during the SARS-CoV-2 pandemic: A position paper from the Home Artificial Nutrition and Chronic Intestinal Failure Special Interest Group of ESPEN

Cited by 9 publications

References 14 publications

Significant Published Articles in 2020 for Pharmacy Nutrition Support Practice

Significant Published Articles in 2020 for Pharmacy Nutrition Support Practice

Organizational issues of home parenteral nutrition during COVID-19 pandemic: Results from multicenter, nationwide study

An International Survey of Clinicians’ Experience Caring for Patients Receiving Home Parenteral Nutrition for Chronic Intestinal Failure During the COVID‐19 Pandemic

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