P1163* A COMPARATIVE MULTI-DISCIPLINARY REVIEW OF HOME PARENTERAL SERVICES PROVIDED AND AUDITED IN 1993 AND 2003.

Abstract

Introduction: Training of families for home parenteral nutrition (HPN) is extremely challenging for multi-disciplinary professionals. The need to evaluate and review programmes and learn from clinical care initiatives and families is paramount. Our 16-year HPN programme for children with intestinal failure continues to be evaluated by the multi-disciplinary nutritional care team. 48 children have commenced HPN. Diagnostic categories: short gut syndrome (n=24), mucosal disorders (n=17) and motility disorders (n=7). It is well recognised that functioning of families receiving HPN is sub optimal with increased tension, social dysfunction and limitations in family activities. Home care packages (HCP) were developed and initiated by the team in response to families’ needs. The aim of the current study was to compare and contrast service needs and treatments of children requiring HPN in 1993 and after the introduction of HCP ten years later in 2003. Methods: Clinical data was reviewed from case notes and discussion with team members, and analysis of community needs of families was instigated. Results: In 1993, 7 patients were on HPN: short gut syndrome (n=4) pseudo obstruction (n=3). 2 females and 5 males. 2 children were <2 yrs and 5 <10 yrs. 28% of children received enteral feeding and all 7 had HPN 7-nights a week. In 2003, 17 children were on HPN; short gut syndrome n=9,pseudo obstruction n=4, microvillous inclusion n=2, protracted diarrhoea n=2. 8 females and 9 males. 6 children <2 yrs old and 13 <10 yrs. 75% of children had nasogastric feeding at the time of review, and less than 50% had nocturnal infusions for <6 nights per week. HCPs were not available in the home in 1993, but in 2003, 82% of families had regular support. This inlcudes setting up HPN and a 24-hr on-call nursing service. HPN is now funded by the Primary Care Trust (PCT). Conclusion: There is an increased diversity of clinical indications for children requiring HPN in 2003 and the dependency of children and their families is higher. This is due to a predominance of children under 10 years. There is a reduction in the number of days for children receiving HPN, alongside increased impetus to push enteral feeds. This is helpful in the prevention of liver disease and gives families additional flexibility but leads to an increased need for nutritional review and biochemical monitoring. This has marked implications for the hospital and community teams and families. HCPs have evolved and progressed over the ten-year period and funding has been redirected from GP to PCT funding. It is essential that these packages are audited and meet the needs of families, providing both medical, nursing and dietetic support.