Evaluation of the appropriateness of parenteral nutrition use in critically-ill adult patients at a community hospital Dwight Burnham, Christen Freeman, Anne Frances Lipscomb DCH Regional Healthcare System - Tuscaloosa, AL
Background/Purpose: Parenteral nutrition involves the provision of nutrients via the intravenous route. In some cases, it is a life-saving therapy in patients who are unable to tolerate oral or tube feedings. The current ASPEN-SCCM consensus guidelines recommend the use of protocols and nutrition support teams to implement strategies that will maximize efficacy and reduce harms of parenteral nutrition. There is evidence to support an association between the use of guideline-driven protocols and nutrition support teams, and a decrease in total costs and complications of parenteral nutrition.
Methodology: This single-center, retrospective cohort study includes adult patients 18 years or older who were initiated on parenteral nutrition while admitted to an intensive care unit from January 2017 through December 2017. Patients who were admitted to the ICU from the floor on parenteral nutrition or from an outpatient setting while on parenteral nutrition were excluded. The primary outcome is a composite endpoint that includes appropriateness of indication, time to initiation of parenteral nutrition, maximum percent daily energy achieved, and maximum percent daily protein achieved. Secondary endpoints included rate of aforementioned appropriateness for each criterion of PN use, rates of hyperglycemia and hypoglycemia, and rate of bloodstream infections.
Results: (preliminary results) 260 patients were screened with 100 patients to be included in the study. Fifty patient charts have been analyzed at this point. Of those patients reviewed, 34 (68%) received appropriate PN therapy, in which all four criteria for appropriateness were met. In regards to the criteria for appropriateness, 44 (88%) had an appropriate indication, 41 (82%) had an appropriate time to initiation, 49 (98%) achieved max goal daily calories, and 49 (98%) achieved max goal daily protein.
Presentation Objective: Identify appropriate use criteria for parenteral nutrition in critically-ill patients.
Self-Assessment: Which risk-assessment tools are used to determine nutrition risk in critically-ill patients?
