Parenteral nutrition is a well-recognised method of providing nutrition to patients with short- or long-term intestinal failure and is best managed by a co-ordinated team approach(Reference Stewart, Mason and Smith1–3). In Portsmouth, the nutrition support team (NST) has been operating for 6 years. Twice weekly ward rounds, daily reviews by members of the NST, regular teaching and support to nursing and medical staff, have made a positive contribution to the management of these patients. Eight standards in the local policy for the management of adult patients on parenteral nutrition are audited annually, based on good practice(2, 3). An electronic database has been designed and audit data collected by members of the team since 2007 – results are presented and trends over the last 3 financial years explored.
The drop in patients receiving PN is 13.5%. The median duration compares with the 8 d from the National Confidential Enquiry into Patient Outcome and Death (NCEPOD)(Reference Stewart, Mason and Smith1). The percentage of patients and the duration of PN delivery are given below:
The number of different clinical specialties requesting PN has reduced over the last 3 years, especially those episodes of short duration (3 d or less), possibly reflecting a greater control on inappropriate usage. The proportion of short-duration PN from the NCEPOD results(Reference Stewart, Mason and Smith1) recently published was 20%, compared to 18, 10 and 20% in Portsmouth, over each of the 3 years. The percentage of patients receiving PN for 3 d or less by specialty was:
The proportion of PN for patients from specialties other than GI surgery has decreased over the 3 years. The most common reason for PN was post-operative ileus which increased from 31% to 50% over the 3 years, the duration of which is difficult to predict. These trends may reflect a decrease in inappropriate PN(Reference Stewart, Mason and Smith1). The number of patients deemed at risk of re-feeding syndrome following local guidelines increased in the last year.
A rise in the last year reflects the findings of NCEPOD(Reference Stewart, Mason and Smith1) who deemed 60.3% were at risk compared to 49.8% as documented. The percentage of referrals, where adequate biochemistry was available for the nutritional assessment to be undertaken, was:
Incomplete biochemistry on referral will potentially compromise the appropriateness of the initial prescription(Reference Stewart, Mason and Smith1–3). These data support the effectiveness of a multidisciplinary nutrition team in managing PN within a district general hospital.
