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General and Risk Management, Patient Safety (including: medication errors, quality control)
Impact of a multidisciplinary intervention program on quality and safety of parenteral nutrition
  1. Martin C. Lopez,
  2. J. Abiles,
  3. F. Ferrer,
  4. J.J. Arenas,
  5. R. Romero,
  6. M. Garrido,
  7. V. Faus
  1. 1Hospital Costa del Sol, Pharmacy, Marbella, Spain
  2. 2Hospital Costa del Sol, Nutrition, Marbella, Spain

Abstract

Background Parenteral nutrition is a live-saving therapy but it is associated with complications.

Purpose Describe the results of a monitoring and intervention program (MIP) in patients with total parenteral nutrition (TPN).

Materials and methods Patients with TPN were selected between May and June, the year before and after MIP implementation. MIP was carried out by a nutritionist, a pharmacist and a hospital pharmacy resident. MIP involved the patient nutritional evaluation (nutritional history, anthropometry and biochemical markers), daily monitoring of vital signs and glycaemia, complete analytical control (weekly, at the beginning and at the end of TPN; including GOT-GPT, GGT, alkaline phosphatase, triglyceride, albumin, prealbumin and electrolytes), management of TPN complications and elaboration of a nutritional report in the patient clinical history.

Results The authors obtained patients before MIP (group 1, n=24) and after MIP (group 2, n=38). Thanks to MIP, quality of TPN was notably increased (table 1). Group 2 had a more appropriate monitoring (analytical control, nutritional evaluation, vital signs monitoring, reports in clinical history), individualised calculation of requirements and less TPN<7 days compared to group 1. After MIP, albumin and prealbumin increased in 66% and 88% of patients, respectively. No patient reached triglyceride >400 mg/dl. 34% of patients showed glycaemia >140 mg/dl (100% were solved adding insulin to TPN). 26% of patients showed hepatic dysfunction due to TPN (50% were solved using cyclic TPN and taurine). Thiamine was added in patients at risk of refeeding syndrome (34%). No refeeding syndrome was reported. None of these results could be calculated in group 1, as this group did not have any kind of monitoring.

View this table:
GRP017 Table 1

Conclusions The implementation of MIP improves the quality, safety and efficacy of TPN. The use of appropriate indicators has led to quantify the benefit provided by MIP. This study shows the importance of multidisciplinary nutritional teams work and the role of the pharmacist in them.

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