Event Title
The appropriate initiation of parenteral nutrition per ASPEN criteria in a community hospital
Location
Suwanee, GA
Start Date
3-5-2022 1:00 PM
End Date
3-5-2022 4:00 PM
Description
Introduction
The American Society for Parenteral and Enteral Nutrition (ASPEN) has published guidelines for the proper initiation of parenteral nutrition (PN) in order to safelyadminister PN.
Objective
The objective of this study is to determine the amount of PN orders that were appropriately initiated according to ASPEN guidelines within the WellStar North Fulton campus.
Methods
This study is a single-center, retrospective chart review over 30 months. The data was collected from Wellstar North Fulton Hospital patients from January 1st, 2019, to July 19th, 2021. The sample size is 115 patients. Appropriate initiation of PN was determined by analyzing how PN is used at WellStar and comparing them to the ASPEN guideline recommendations. Patient charts were reviewed to determine if a patient is appropriately receiving per ASPEN guidelines. An appropriate use assessment was conducted which included indication, timing, and duration of PN orders. The primary endpoint is the appropriate initiation of PN at Wellstar North Fulton Hospital. Secondary endpoints studied included the service line of provider writing PN order and the total cost of PN. Inclusion criteria includes all patients over the age of 18 who had PN orders from January 1st, 2019 to July 19th, 2021. Exclusion criteria excludes all patients under the age of 18 year who had not received PN. Data collected includes patient demographics such as age, gender, admission date, PN administration date and duration. Prescriber information and service line was also collected.
Results
A total of 115 charts were reviewed. Of these charts, 109 had PN administered. Of these administrations, 64 were determined to be appropriate (58.7%) while 45 were determined to be inappropriate (41.3%). The most common reason for inappropriate PN orders was duration, with 22 out of 45 patients (48.0%) followed by timing with 16 out of 45 patients (35.6%) and indication with 14 out of 45 patients (31.1%). Additionally, 12 out of 45 patients (26.7%) had concurrent enteral nutrition/PN or adequate oral intake and 5 out of 45 patients (11.1%) were determined to be eligible for enteral nutrition. Thirteen out of 45 patients (28.9%) had multiple reasons for inappropriate factors. Inappropriate PN loss accounted for $10,839-$13,775. Regarding prescribers, 30 out of the 45 inappropriate PN orders were written by the internal medicine service line (66.6%) followed by 7 out of the 45 inappropriate PN orders were written by the critical care service line (15.5%). Eight out of the 45 inappropriate PN orders were written by all other service lines (17.7%).
Discussion/Conclusion
Compared to other single-center studies, the studied facility holds up well when compared to other facilities pre-intervention. Targeted education to individual prescribers and service lines are planned in order to increase appropriate initiation of PN. Additionally, greater communication between physicians and pharmacists can increase appropriate use of PN.
Included in
The appropriate initiation of parenteral nutrition per ASPEN criteria in a community hospital
Suwanee, GA
Introduction
The American Society for Parenteral and Enteral Nutrition (ASPEN) has published guidelines for the proper initiation of parenteral nutrition (PN) in order to safelyadminister PN.
Objective
The objective of this study is to determine the amount of PN orders that were appropriately initiated according to ASPEN guidelines within the WellStar North Fulton campus.
Methods
This study is a single-center, retrospective chart review over 30 months. The data was collected from Wellstar North Fulton Hospital patients from January 1st, 2019, to July 19th, 2021. The sample size is 115 patients. Appropriate initiation of PN was determined by analyzing how PN is used at WellStar and comparing them to the ASPEN guideline recommendations. Patient charts were reviewed to determine if a patient is appropriately receiving per ASPEN guidelines. An appropriate use assessment was conducted which included indication, timing, and duration of PN orders. The primary endpoint is the appropriate initiation of PN at Wellstar North Fulton Hospital. Secondary endpoints studied included the service line of provider writing PN order and the total cost of PN. Inclusion criteria includes all patients over the age of 18 who had PN orders from January 1st, 2019 to July 19th, 2021. Exclusion criteria excludes all patients under the age of 18 year who had not received PN. Data collected includes patient demographics such as age, gender, admission date, PN administration date and duration. Prescriber information and service line was also collected.
Results
A total of 115 charts were reviewed. Of these charts, 109 had PN administered. Of these administrations, 64 were determined to be appropriate (58.7%) while 45 were determined to be inappropriate (41.3%). The most common reason for inappropriate PN orders was duration, with 22 out of 45 patients (48.0%) followed by timing with 16 out of 45 patients (35.6%) and indication with 14 out of 45 patients (31.1%). Additionally, 12 out of 45 patients (26.7%) had concurrent enteral nutrition/PN or adequate oral intake and 5 out of 45 patients (11.1%) were determined to be eligible for enteral nutrition. Thirteen out of 45 patients (28.9%) had multiple reasons for inappropriate factors. Inappropriate PN loss accounted for $10,839-$13,775. Regarding prescribers, 30 out of the 45 inappropriate PN orders were written by the internal medicine service line (66.6%) followed by 7 out of the 45 inappropriate PN orders were written by the critical care service line (15.5%). Eight out of the 45 inappropriate PN orders were written by all other service lines (17.7%).
Discussion/Conclusion
Compared to other single-center studies, the studied facility holds up well when compared to other facilities pre-intervention. Targeted education to individual prescribers and service lines are planned in order to increase appropriate initiation of PN. Additionally, greater communication between physicians and pharmacists can increase appropriate use of PN.