Clinical indicators are valuable in assessing parenteral nutrition

Abstract

The purpose was to evaluate the nutritional care of adult patients receiving parenteral nutrition by determining a) frequency of clinical indicators and b) whether indicators were associated with patient outcomes. Indicators were similar to those recently developed by a Joint Commission on Accreditation of Health Care Organizations task force. Records of 205 patients who received total parenteral nutrition (TPN, n = 166) or peripheral parenteral nutrition (PPN, n = 39) were studied retrospectively. Associations among indicators and outcomes were determined using stepwise multiple regression. Associations among indicators and deaths were determined using chi square. Percent occurrence of indicators for TPN were: hypophosphatemia (< 1.6 mg/dl) 11%, hypokalemia (< 3.0 meq/1) 13%, hyperglycemia (> 200 mg/dl for 2 consecutive days) 32%, lipid-free solutions (> 10 days) 4%, lack of documentation justifying TPN 31%, and micronutrient free solution 6%. Percent occurrence of hyperosmolar PPN solutions (> 650 mOsm/L) was 56%. In TPN patients, hypophosphatemia was associated (F > 4.0) with an increase of 10.2 hospital days, 10.8 ICU days, and 2.9 solution reformulations; hypokalemia was associated with an increase of 10.7 hospital days, 11.9 days of TPN feeding, and 2.3 reformulations; hyperglycemia was associated with an increase of 2.6 solution reformulations, and 4.2 days of TPN therapy; hyperglycemia was associated with increased number of deaths (p < .001); lack of lipids was associated with an increase of 16.2 ICU days; lack of justification for TPN was associated with 5.2 fewer days of TPN therapy. Although associations do not indicate causal relationships, the indicators occurred frequently, were associated with adverse patient outcomes and appear to be appropriate for use in evaluating nutrition care of patients who received TPN. Clinical indicators provide health care personnel a tool for continuous quality improvement of metabolic complications associated with parenteral nutrition. The study identifies areas of research that need further evaluation.