Background In June 2010 a report, ‘A Mixed Bag – An enquiry into the care of hospital patients receiving parenteral nutrition’, was published by the National Confidential Enquiry into Patient Outcome and Death (NCEPOD). They reviewed 870 adult case notes and found inadequate assessment and monitoring in 54% and metabolic complications in 40% of patients.
Purpose In early 2011 the adult nutrition support team (NST) wrote the clinical guidelines on the prevention and management of refeeding syndrome. The aim of this audit was to evaluate the impact of the NST in the management of refeeding risks in adult patients who required parenteral nutrition (PN).
Materials and Methods Adult PN records from April 2011 to March 2012 were assessed retrospectively by NST members using the NCEPOD Parenteral Nutrition Audit Tool. Microsoft Excel spreadsheets were used to record information on assessment and management of refeeding risks.
Results 259 PN records were reviewed. 54% (140/259) patients were assessed and monitored by NST and 44% (114/259) by critical care teams. The NST found a risk of refeeding syndrome in 31.4% (44/140) of patients prior to starting PN. The non-medical prescribers (NMPs) of the NST prescribed intravenous electrolyte infusions to 88.6% (39/44) of patients who were at high refeeding risk (see Table 1). Four patients had BMI less than 16 kg/m2. The NMPs prescribed the lowest calorie feed (1250 ml Nutriflex Peri 5.7) and the infusion rate was reduced by 50% for the first two days in order to minimise metabolic complications.
Conclusions All adults referred to the NST for parenteral nutrition were reviewed and assessed for refeeding risk. The NMPs prescribed a range of intravenous electrolyte infusions to 88.6% of patients who were at high refeeding risk. This proactive prescribing approach by NMPs prevented the development of meta bolic complications associated with low electrolyte levels prior to starting PN.
No conflict of interest.
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