Parenteral Nutrition Utilization: Evaluation of an Educational Protocol and Consult Service

Abstract

A two part study was undertaken to evaluate the effectiveness of an educational protocol and consult service on parenteral nutrition (PN) utilization. Forty-one patient admissions were evaluated retrospectively and nine prospectively. Average length of hospital stay and number of days on PN were decreased significantly (p less than .05). Frequency of adverse effects were also decreased significantly (p less than .05). A positive trend toward selection of patients for enteral rather than PN was evidenced. Utilization of already available manpower and financial resources by this modified approach should contribute toward reducing costs and hazards of PN therapy, particularly for smaller hospitals with both limited requirements and resources, as well as for teaching institutions.

Effectiveness of a multidisciplinary total parenteral nutrition team in the hospital setting

“…Using the criteria for classification of studies promulgated by the National Health and Medical Research Council, no randomised‐controlled trails were identified. All 11 studies were comparative in design, 1,2,4,5,7,12–17 four with concurrent controls 2,4,5,12 and seven with historical controls 1,7,13–17 …”

“…The remaining study was conducted in two hospitals, one hospital was used as the intervention and the other as the control group 5 . The included studies were conducted in Spain, 13 the USA, 1,2,4,7,12,15–17 Singapore 14 and the UK 5 . The study period ranged from 2 weeks 2 to 3 years 17 …”

“…The age of the patients ranged from 26 2 to 93 years 15 (mean age 59.2 years and median age 58.6 years). Comparability between groups for age was reported in 10 studies 1,2,4,5,12–17 and for gender in eight studies 1,2,4,12–14,16,17 . The studies that reported on baseline characteristics for age and gender found them to be comparable.…”

“…The sample sizes in the trials were generally small and ranged from 28 2 to 285 17 subjects with five studies having unequal sample sizes between the comparison groups 1,4,7,15,17 . The mean duration for the administration of TPN therapy ranged from 7.1 days 2 to 26 days 16 and was administered using either a central 1,4,5,7,12–15,17 or peripheral 5,7,12 venous catheter. In two studies patients received oral and or enteral nutrition during the transitional phase of TPN therapy 3,5 .…”

“…The members of the TPN team, and the roles and responsibilities of the team and its members, varied between the studies. The members of the team consisted of the following health professionals: pharmacist, 1,2,4,5,12–17 dietitian, 1,2,4,7,12–15,17 nurse, 1,4,5,7,12,14–17 surgeon, 14 endocrinologist, 13 anaesthetist, 14 medical interns/resident, 1,14 paediatrician, 14 physician specialising in clinical nutrition, 1 MD clinical nutrition fellow, 1 consultant biochemist, 5 consultant gastroenterologist, 5 physician, 4,7,12 physicians from surgical and medical services, 15 attending gastroenterologist, 17 gastroenterology fellow, 17 research assistant, 14 and hospital epidemiologist 15 . In some studies, the TPN team provided a consultative service, and in others they assumed total responsibility for the nutritional management of the patient.…”