Introduction NICE Nutrition Support In Adults (2006) recommends that all Trusts should have a multidisciplinary Nutrition Support Team (NST). Austin & Stroud (2007) suggest its implementation can improve parenteral nutrition (PN) services and potentially reduce PN usage by up to 25%. At Croydon University Hospital (CUH), a multidisciplinary NST was set up in October 2010, consisting of a Consultant Chemical Pathologist, Consultant Gastroenterologist, dietians and pharmacists. It combined the previous PN team with the enteral nutrition (EN) team with the aim to optimise the EN of patients thereby reducing inappropriate PN usage as recommended by NCEPOD 2010. We aimed to investigate the use of PN 1 year prior to the implementation of a multidisciplinary NST and compare this to the use of PN 1 year post-implementation at CUH.
Methods Case notes of patients who had received PN at CUH between 1st October 2009 and 30th September 2010 were obtained and a retrospective analysis of each patient's duration on PN was made and compared to prospective data, obtained from the start of the introduction of a multidisciplinary NST on 1st October 2010, until September 30th 2011. The final cost of PN was obtained from the hospital pharmacy and cost-savings were calculated.
Results Data obtained before and after implementation of NST: The total cost of PN per day is £156.60. The median number of days was reduced by 1 day. In the year following the introduction of the NST, 60 patients received PN (saving 60 days of PN), 12 patients were successfully prevented from receiving PN (saving 72 days of PN). The total number of PN days saved was 132, resulting in a total cost saving of £20 671.20. This does not take into consideration the reduction in PN days as result of reduced waiting time for procedures to facilitate EN.
Conclusion Implementation of NST resulted in:
12 patients (40%) were successfully prevented from inappropriately starting PN and the median duration of PN reduced by 1 day - A total reduction of 132 less PN days.
The number of peripheral PN days was reduced by 189.5 days.
A reduction in the number of patients on PN awaiting a procedure to facilitate EN.
A conservative estimate of £20 671.20 was saved as a result.
Competing interests None declared.
References 1. Austin, Stroud. 2007.
2. Nutrition Support In Adults. NICE, 2006.
3. A Mixed Bag. NCEPOD, 2010.
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