Parenteral Nutrition (PN) Use for Adult Hospitalized Patients: A Study of Usage in a Tertiary Medical Center

Abstract

The use of parenteral nutrition (PN) is essential for patients who are unable to meet their nutrition requirements through oral or enteral nutrition. Many earlier studies have noted that PN is often inappropriately used in the hospital setting, thereby increasing the risk of associated complications and costs. A prospective study was performed at the Medical University of South Carolina (MUSC), using a nutrition support database to determine the appropriateness of PN use and the associated hospital costs for patients on 3 surgical services over a 6-month period. Appropriateness of PN therapy was determined according to the American Society of Parenteral and Enteral Nutrition (A.S.P.E.N.) guidelines. A total of 139 new PN therapies were initiated in the 6-month period. Forty percent of the cases were deemed inappropriate. A total of 573 PN days ($80,000 hospital PN costs) could have been saved if inappropriate PN therapy had not been ordered. The avoidable costs only reflect the PN solution and not the additional costs associated with laboratory monitoring, central line placement and maintenance care, nursing administration, and ongoing pharmacy and dietitian clinical management. This study illustrated that PN was not always being provided according to A.S.P.E.N. guidelines. In addition, cost savings could be achieved if PN was provided only to MUSC patients who meet these guidelines.

Parenteral Nutrition Utilization After Implementation of Multidisciplinary Nutrition Support Team Oversight

“…‐ 15 The observed trends in PN utilization after 2007 suggest that multidisciplinary nutrition meetings effectively change practice behaviors and encourage more judicious selection of patients for PN therapy. This study represents the largest known patient cohort related to this topic in the literature and corroborates multiple prior studies that have shown that multidisciplinary nutrition teams are associated with decreased PN utilization 1 , 3 . ‐ 5 , 16 …”

“…Moreover, both short‐duration PN (<5 days) and PN given to supplement partial enteral support results in known risks without any definitively proven benefits, 6 , 13 ‐ 16 with the exception of a single study that showed benefit in one patient subpopulation 19 . Cost of therapy is also substantial and is estimated at $140–$300 per day 1 , 4 . Although our study did not specifically evaluate clinical and financial outcomes, multiple prior studies have shown that reducing PN use is associated with reductions in morbidity and hospital costs 1 , 3 , 4 .…”

“…Multidisciplinary teams in other arenas of medicine are proven to improve the consistency of evidence‐based care and reduce hospital costs 9 . ‐ 11 Nutrition teams have also proven effective in this regard, by both increasing guideline adherence and reducing costs of indiscriminate therapy 1 , 4 . ‐ 6 Moreover, the Joint Commission on Accreditation of Health Care Organizations recommends that hospitals employ “interdisciplinary and collaborative care” to establish and maintain nutrition support plans 20 .…”

“…PN utilization has declined considerably since the implementation of such teams in U.S. intensive care units (ICUs) more than a decade ago 7 . However, hospitals without multidisciplinary team meetings still experience substantial practice variation in PN utilization 1 , 8 . Multidisciplinary teams from other arenas of medicine help improve the consistency of evidence‐based care delivery, including in cardiac arrest, 9 acute pain management, 10 and mechanical ventilation 11 …”

Assessing Appropriate Parenteral Nutrition Ordering Practices in Tertiary Care Medical Centers

“…Despite these efforts, recent published reports indicate that hospitals continue to inappropriately prescribe PN 13 . ‐ 15 Inappropriately prescribed PN not only carries a clinical risk but places a substantial economic burden on the hospital 16 , 17 .…”