Aims

A multidisciplinary team for the management of parenteral nutrition (PN) improves patient outcomes and provides cost-savings for health services. This study aimed to (1) pilot a multidisciplinary PN team; examining appropriateness of PN prescription/monitoring, line management, complications, nutritional provision and cost implications; (2) provide recommendations regarding potential improvements to PN provision and service practices.

Methods

Prospective data was collected pre and post implementation of a PN team on all patients commencing PN. Patient demographics, length of PN usage, appropriate monitoring of clinical parameters, metabolic and line complications, nutritional adequacy, cost of PN and length of stay (LOS) were recorded. PN management was compared to the hospital PN policy and best-practice guidelines and an evaluation survey of staff was conducted.

Results

Twenty patients commenced PN pre-implementation and 28 post-implementation (45% haematology patients). Both periods had equal median length of PN delivery at 7.5 days and PN hang times at 24 hours. Post-implementation improvements were observed in the adherence to monitoring parameters as specified by the PN policy and positive blood cultures (likely secondary to line complications) reduced from 25% to 21% of patients. Thirty five percent of both groups failed to meet >80% of their nutritional requirements whilst on PN. The median patient cost of PN was A$581 and A$537 respectively and median LOS for patients was recorded as 22 days for both cohorts. The staff survey revealed improved knowledge surrounding PN prescription, PN processes, monitoring and highlighted practice improvements and a reduction in clinical risk. Support for implementation of the PN team into usual care was high at 85%.

Conclusions

This study identified inconsistencies in the prescription and monitoring of PN, however it demonstrates improved patient management and reductions in complication rates and costs with operation of a PN team. This work supports implementation of the PN team into usual care, highlighting clinical and organisational benefit.