Introduction Total parenteral nutrition (TPN) is an invasive feeding method, with stringent indications due to higher associated cost and morbidity. The National Confidentiality Enquiry into Patient Outcome and Death (NCEPOD) review – A Mixed Bag,1identified good clinical practice in only 19% of patients receiving TPN as recently as 2010. We present improvements in standards of care for patients receiving TPN, which were found on completion of an audit cycle at our institution.
Method Retrospective data collection was undertaken on all patients receiving TPN from December 2013–January 2014 at The Countess of Chester Hospital (Audit 2). This was compared to the same dataset extracted from November 2010–February 2011 (Audit 1). NCEPOD1and NICE2guidance recommendations were used as gold standards.
Results Over the 13 month period, 64 patients received TPN. The median age was 68 (range 23–89); male:female ratio 1.5:1. Median duration of TPN was 8 days (range 1–144 days). TPN was commenced in level 1 care in 59.4% of cases; level 2/3 40.6%. 36 patients (56%) received TPN via a dedicated PICC line and 28 (44%) through a central line. Data comparison between audit 1 and 2 is tabulated below.
Conclusion Early involvement and supervision by the nutrition support team remained at a high standard. Following earlier recommendation, major improvements were seen in the monitoring of daily bloods, obtaining central venous access, and documentation of weekly weight measurements. A multi-disciplinary electronic referral and assessment proforma is now being developed to enable NCEPOD targets to continue to be met.
Disclosure of interest None Declared.