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PTH-199 Home parenteral nutrition: safe and effective documentation
  1. I Beeby,
  2. J Elston
  1. Fresenius-Kabi, Telford, UK

Abstract

Introduction The aim of The Care profile was to develop a robust system of nursing documentation. This was to ensure the provision of safe, evidence based nursing care in the delivery of home parenteral nutrition with improved patient clinical outcomes.

Method Standards in Nutritional Care have been widely documented as unsafe and calls for improved care highlighted in many recent reports. BAPEN specifically supports the implementation of Care Pathways and includes this as one of the key areas of guidance in the, Malnutrition Matters Toolkit. Improved clinical outcomes and prevention of patient deterioration at home requires robust systems to be in place and used effectively. In response to the High impact intervention Catheter Care Bundle and Epic guidelines we commissioned the development of a new consistent, transparent, equitable document. We developed a working party. We carried out a review of current documentation. Questionnaires about current documentation were circulated across the national nursing team. These were reviewed; the results guided our change process. A literature search was undertaken; this included reviewing current local and national guidelines in Central Venous Access Devices and Parenteral Nutrition. We reviewed care pathways across a variety of health care settings. Version 1 of the Intravenous Care Profile was created. In consultation with our engaged Stakeholders we selected a pilot group and trialled the document. Clinical and documentation audits were developed and used following a three month trial. Audit helped to provide a way of improving and measuring the implementation of key elements of care. Audit 1 results guided adaptation of version 1, Audit 2 results reflected the improvements made; the clinical audit achieved 100% the documentation audit score close at 98%. A national rollout followed. Audit has allowed a cycle of continuous development and improvements to the document. An awareness of local and national influences has helped us understand how to use clinical governance systems including audit to make improvement happen in our area. Using the care profile in our routine daily clinical practice, the risk to patients was minimised. A programme of training was implemented across the company to ensure effective use of the care profile was achieved.

Results The document is intended to provide a structured approach to improve clinical outcomes. It aims to support local and national guidelines that support improvement in standards of care. In collaboration with our stakeholders we have seen a marked change when reviewing anecdotal evidence of reduction of patient hospital readmission for Parenteral Nutrition related issues. In 2015 we will develop our audit systems and review patient data to investigate the perceived improvement in clinical outcomes and reduction in hospital bed days.

Conclusion See results.

Disclosure of interest None Declared.

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