PTU-089 The clinical effectiveness of the nutrition support team – an acute district general hospital experience

Abstract

Introduction The George Eliot Hospital NHS Trust is a 310 bed acute district general hospital. The Nutrition Support Team consisting of a consultant gastroenterologist, nutrition nurse, speech and language therapist and a dietitian were established in 2011. This audit explores the safety and effectiveness of a multi-disciplinary nutrition support team (NST) in enteral and PN delivery. Data on 30 day mortality rates for gastrostomy feeding tubes and, line sepsis rates and appropriateness of patients receiving parenteral nutrition (PN) were analysed for both before and after the establishment of the NST. Methods Prospective and retrospective data was collected from medical notes, dietetic records and NST meeting documentation. Two Separate audits were completed including mortality rates post-PEG placements with and without NST input and parenteral feeding venous line sepsis rates with and without NST input. Data was collected for patients who underwent PEG insertions and PN. 30 day mortality from PEG insertions and prevalence of line sepsis was analysed for period of 2010–2011 (before NST was established) and 2014 onwards (after establishment of NST). The data collected were compared to the findings from the NCEPOD report (2010). Results Enteral Feeding In 2010–11, prior to the formation of the NST, 61 patients had gastrostomy feeding tubes placed within the hospital; of which 19 of those patients died within 30 days. This would equate to a 31% 30 day mortality rate. Data from three years with NST input covering 2014–16 showed that 63 gastrostomy tubes were placed, of which only 3 patients died within 30 days which equates to a 5% mortality rate. Parenteral Feeding Data collected from a report by NCEPOD (2011) which looked into the national average prevalence of line sepsis associated with PN showed a confirmed sepsis of 6% and a suspected line sepsis of 9.4%. Data collected from a two year period 2014–16 since NST had been established included 72 patients that showed confirmed line sepsis of 2.7% and a suspected line sepsis rate of 2.7%. Conclusions The NST has improved the safety and efficacy of enteral and PN therapy in our trust. NST which has managed to decrease line sepsis and mortality rate of gastrostomy placements since its formation in 2011. Prior to 2011, individual professionals worked in isolation with inconsistent communication between them. Patients were assessed by a nutrition nurse with focus on fitness for tube placement. The cohesive multidisciplinary team (MDT) approach to nutrition allows a more holistic assessment and treatment of the patient. Specialists within their fields discuss up to date information of the patient’s medical and nutritional status which can allow best interest decisions to be made alongside family members and other healthcare professionals as appropriate. This has ensured that placement of gastrostomy tubes is appropriate and within the window of opportunity in patients with progressive neurological conditions, preventing crisis in later stages of disease. PN associated line sepsis has decreased since the formation of NST who have clinical ownership of the initiation and monitoring within the hospital. The NST has initiated protocols and has developed guidelines which advise on ways to maintain patient safety including PN specific wards, bedside PICC insertion service and establishing training for ward nursing teams.