Tube flushing and drug administration practice in patients in the community on enteral feeding

Abstract

ICU, 17% Progressive Care Unit, 34% surgical wards, 5% oncology and 2% admissions ward. In total 640 bags were used. Weight was recorded in only 58% patients. 47% lines used for TPN were PICC, 46% central jugular, 3% peripheral, remaining 3% represents Hickman, femoral and subclavian lines. TPN formulations used ranged from 5g to 16g Nitrogen. 28% of the TPN prescribed were scratch bags. The average number of days on TPN was 11, however 28% were on 4 days or less. Problems associated with TPN included absence of biochemical monitoring, safety checks not being carried out prior to administration, TPN bag given to the wrong patient, broken circuits, TPN stopped inappropriately and the unsafe use of Kabiven 9 bags kept on ICU. Outcomes once TPN was stopped: 54% weaned onto oral diet, 22% onto NG feed, 5% on NJ feed, 3% PEJ/RIG, 3% transferred to another hospital, 4% LCP, 9% RIP. There has been a vast improvement in the use of TPN since the Nutrition Team was established. In 2004, 185 patients were prescribed TPN, compared to only 67 in the present audit. This reflects improved understanding of the indications for TPN and optimisation of enteral feeding routes. In 2003 TPN was not indicated for 14% of the patients but this audit reports only 3% inappropriate referrals. Other results are similar, e.g. the average length of time on TPN: 10 days (2004) vs 11 days (2012). It also demonstrates significant recurrent cost savings, for example, the number of bags used in 2012 was 1550 less bags than in 2003, reflecting more than £143,000 saved. However, some areas of concern continue since 2004.