title: Home parenteral nutrition in Scotland: frequency of monitoring, adequacy of review and consequence for complication rates.
abstract: OBJECTIVE
  Home parenteral nutrition (HPN) has been a major advance in the management of patients with gastrointestinal failure. It demands regular monitoring to ensure optimal intake, assess treatment response, and minimize complications. The Scottish Home Parenteral Nutrition Managed Clinical Network (MCN) produced a guideline advising three-monthly monitoring of biochemistry, micronutrients, vitamins, weight, and anthropometry. This study assesses the frequency and adequacy of monitoring of these complex patients and investigates any effect of this on complication rate.
  
  
  METHODS
  All patients receiving HPN funded by the National Health Service in Scotland are known to the MCN via the National Contract for provision of HPN. Data are collected in an MS Access database; 2006 data is extracted.
  
  
  RESULTS
  There were 141 HPN clinic assessments for 53 patients. Sixteen (30%) were seen every 100 d as recommended by the guideline. Sixty percent of reviews were within 100 d of the previous appointment. Duration of HPN treatment inversely correlated with frequency of review. Bloods were checked at 93% of reviews, weight at 86%, anthropometry at 24%, and vitamins and micronutrients measurement at 62% of clinics. No difference in complication rates was found between those reviewed within the recommended time periods and those reviewed less often.
  
  
  CONCLUSIONS
  Less than one-third of patients met the current recommended review frequency. Routine bloods and weight measurements were good, micronutrients less so; anthropometry is poorly monitored. Complication rates were not increased in HPN patients reviewed less often.
authors.affiliation: Department of Surgery, Glasgow Royal Infirmary, Glasgow, United Kingdom. nikkihallum@hotmail.com
authors.forename: Nicola Simone
authors.initials: NS
authors.lastname: Hallum
authors.forename: Janet P
authors.initials: JP
authors.lastname: Baxter
authors.forename: Denis St J
authors.initials: DS
authors.lastname: O'Reilly
authors.forename: Ruth F
authors.initials: RF
authors.lastname: McKee
mesh_terms: D000554:Ambulatory Care Facilities; D000886:Anthropometry; D001835:Body Weight; D019058:Community Networks; D005260:Female; D005767:Gastrointestinal Diseases / Q000097:blood / Q000150:complications* / Q000628:therapy*; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D016347:Medical Records Systems, Computerized; D018977:Micronutrients / Q000097:blood; D008875:Middle Aged; D016331:Parenteral Nutrition, Home / Q000009:adverse effects; D017410:Practice Guidelines as Topic; D012606:Scotland; D013222:State Medicine; D013997:Time Factors
chemical_list: D018977:Micronutrients