Background Parenteral nutrition (PN) is an essential supportive treatment for patients who are unable to meet their nutrition requirements through oral or enteral nutrition. Many studies have noted that PN is often inappropriately prescribed, thereby increasing the risk of associated complications and costs.
Purpose To determine the quality of prescription of PN in our hospital, based on the ESPEN 2009 guidelines and the pharmacy cost.
Material and methods A prospective, observational study of PN episodes in adults was over a 3-month period. The use of PN was classified as ‘appropriate’ or “inappropriate”. Variables collected included: demographic data, underlying diagnoses, indication for PN, number of days on PN and complications related to PN in inappropriate use such as phlebitis, metabolic complications and bacteraemia associated with central venous catheter (BAC). We calculated the cost of the number of inappropriate PN treatments provided.
Results We reviewed the indications for 90 PN treatments. The patients were 53% male with median age of 63.9 years (range, 27 to 96 years), with a principal diagnosis of digestive tract neoplasia (37.8%). In 37.8% of the cases PN was “inappropriate”; the most common indications were prolonged fasting (22.9%), palliative care (20%) and patient refusal to eat (8%). The median duration of “inappropriate” PN prescription was 4.9 days (range, 1 to 17 days). Six patients (17.6%) had complications; 3 cases of BAC, four metabolic complications, and two cases of phlebitis. The number of inappropriate PN treatments was 163 units which cost the pharmacy €6,130.57 for the PN.
Conclusion PN is associated with complications; because of this the indication for PN should comply with the main clinical practice guidelines and requires monitoring by experienced professionals in multidisciplinary Nutritional Units.
In addition, cost savings could be achieved if PN was provided only to the patients who meet these guidelines.
References and/or acknowledgements Thanks to my co-workers.
No conflict of interest.