Development of quality of care interventions for adult patients on home parenteral nutrition (HPN) with a benign underlying disease using a two-round Delphi approach.
OBJECTIVE
HPN patients with benign diseases deserve professional care as they have to deal with complex techniques and risk potentially dangerous complications. The aim was to highlight main outcome quality indicators and to develop a set of key interventions to direct multidisciplinary teams in providing qualitative care.


METHODS
A two-round Delphi approach was used to build consensus on the most important outcome indicators and on 59 interventions identified in existing guidelines on HPN. Comments and interventions newly identified in the first round were co-evaluated in the second round.


RESULTS
29 experts from 9 countries completed the two-round Delphi approach. The outcome indicators rated as the most important are 1) incidence of catheter-related infections, 2) incidence of readmission and quality of life (shared second place) and 3) incidence of dehydration. Sixty eight of a total of 89 interventions were considered as important for the quality of care, of which 46 are based on published guidelines and 22 were newly suggested by the Delphi panel.


CONCLUSIONS
Using a two-round Delphi approach, consensus was reached for the majority of interventions concerning HPN patients with benign diseases. This set of 68 interventions could be of use as a starting point for quality-improvement programs.
Department of Pharmaceutical and Pharmacological Sciences, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Leuven, Belgium. mira.dreesen@uzleuven.be
Mira
M
Dreesen
Veerle
V
Foulon
Kris
K
Vanhaecht
Martin
M
Hiele
Lutgart
L
De Pourcq
Loris
L
Pironi
Andre
A
Van Gossum
Geert
G
Wanten
Janet P
JP
Baxter
Francisca
F
Joly
Cristina
C
Cuerda
Ludo
L
Willems
D000328:Adult; D055499:Catheter-Related Infections / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D032921:Consensus; D003681:Dehydration / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D003697:Delphi Technique; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016331:Parenteral Nutrition, Home / Q000009:adverse effects* / Q000451:nursing / Q000523:psychology; D010348:Patient Care Team; D010359:Patient Readmission; D017410:Practice Guidelines as Topic; D011361:Professional Competence; D058996:Quality Improvement; D019984:Quality Indicators, Health Care; D011788:Quality of Life; D012958:Societies, Scientific