Impact of the creation of a nutritional support team on the quality, safety and effectiveness of total parenteral nutrition

Abstract

Parenteral nutrition (PN) is an essential component in the treatment of many hospitalized patients; however its use is associated to severe complications. The monitoring of these patients has been demonstrated as an effective method for the success of nutrition therapy; therefore, nutritional support teams play an important role to increase the effectiveness and efficiency of the PN. In Spain, there is no data available about the situation of nutritional support teams in hospitals. Develop a nutritional support team in our hospital and analyze the interventions and outcomes in terms of quality, effectiveness and safety. Retrospective, cross-sectional study. Patients with PN were selected during two months, corresponding to the period before and after the creation of the nutritional support team (group 1 and 2, respectively). The functions of the nutritional team include: nutritional evaluation, daily monitoring of vital signs and glycemia, detailed analytical control, management of PN complications, between others. 67% of patients in group 1 (n = 24) maintain the PN < 7 days, versus 22% in group 2 (n = 38). In group 1, no patient had a nutritional assessment, neither daily vital signs monitoring (100% in group 2). Detailed analytical control was carried out in the 4% of group 1 and 79% of group 2. In group 2, albumin and prealbumin levels remain stable or increased in the 66% and 88% of patients, respectively. No patient reached triglyceride > 400 mg/dl. 34% of patients showed glycemia > 140 mg/dl (100% of them were solved), and 26% of patients underwent hepatic dysfunction (50% were solved). No refeeding syndrome was reported (thiamine was added to PN in 34% of patients). the nutritional support team work has notably increased the quality, safety and effectiveness of PN. This study demonstrates the need to incorporate multidisciplinary nutritional teams in hospitals and the benefit obtained in the patient medical care.