Evaluation of Parenteral Nutrition Management in a Hospital without a Formal Nutrition Support Team

Abstract

Purpose A preliminary review of several adult inpatients receiving parenteral nutrition (PN) revealed opportunities for improvement. In response, a drug usage evaluation (DUE) was conducted to: 1) determine specific areas of adult PN management needing improvement; 2) evaluate the current PN order forms; 3) identify reasons for PN wastage; 4) establish pharmacist involvement in prescribing/monitoring of PN in a community hospital without a formal nutrition support team. Methods A prospective DUE was performed on various adults receiving PN from January through February 2005. The following data were collected and evaluated: 1) PN indication; 2) whether ordered PN formula met patients' estimated needs; 3) adequate adjustments of electrolyte or glucose imbalances; 4) appropriate ramping/tapering of PN; 5) appropriate laboratory data ordered. Additionally, a record was kept of PN solutions wasted from January through April 2005. Results Twenty-two adult patients receiving PN were prospectively reviewed. Protein and caloric needs were met in only 59% of patients (n = 13), and electrolytes were abnormal in 73% of patients (n = 16), with most physicians making minimal or no electrolyte adjustments. PN was not routinely ramped up upon initiation. Phosphorus, triglycerides, and prealbumin were not routinely monitored. An average of 14.5 PN bags was wasted per month. In response to these findings, the PN order forms were redesigned to facilitate appropriate monitoring and to facilitate physician-initiated consults for pharmacists to manage PN. One year after implementation, a 40% reduction in PN wastage was noted. Conclusions Pharmacists play an integral role in PN management, resulting in improved patient monitoring and a reduction in expensive PN wastage.