Background Total Parenteral Nutrition (TPN) isn’t always prescribed according to international guidelines: nutritional screening is frequently lacking, the prescribed therapy is not always adapted accordingly and subsequent monitoring is often absent. Our objective was to assess the potential benefit of a clinical pharmacist reviewing prescribed TPN.
Purpose Evaluation of the appropriateness of prescribed TPN.
Material and methods Setting: A prospective pre-post intervention study in a tertiary care teaching hospital with a high percentage of cancer and critically ill patients.
Method: Adult hospitalised patients on TPN were included. The presence of a Nutritional Risk Screening-2002 and the calculation of energy requirements, the indication, the therapy appropriateness and the therapy duration were assessed by a clinical pharmacist. During the intervention period feedback was provided to the physician and dietician in multidisciplinary collaboration. The ESPEN guidelines were taken as golden standard. All data were obtained from the electronic patients files.
Results We assessed 272 hospitalisations, 152 pre-interventional (10/2013–01/2014) and 120 post-interventional (02/2014–04/2014). During the latter period an intervention was needed in 83.7% (176 interventions) of the cases. Prevalence of nutritional screening increased from 25.0% to 61.7% (p < 0.001) as did energy requirement calculation (30.9% vs. 67.5%; p < 0.001). Therapy appropriateness increased from 58.8% to 75.8% (p < 0.05). The median duration (6.0 vs. 7.0 days) of the therapy was not significantly reduced (p = 0.36). We avoided the production of at least 81 TPNs on a total of 1172. During the 3 month intervention period an estimated total saving of 20756€ could be obtained.
Conclusion The additional monitoring of the appropriateness of TPN by a clinical pharmacist has a positive influence on therapy quality and healthcare costs.
References and/or acknowledgements
ESPEN guidelines (http://www.espen.org/education/espen-guidelines)
Nutrition support team
References and/or acknowledgementsNo conflict of interest.
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