Adherence to the National Institute of Clinical Excellence guidance on parenteral nutrition screening is not enough to improve outcomes.
OBJECTIVE
Majority of the National Institute of Clinical Excellence (NICE) nutrition guidance recommendations were based on Grade D evidence due to absence of randomised controlled trials. The aim was to assess outcomes of parenteral nutrition (PN) administration when the guidance was adhered to.


METHODS
The prospective study included patients referred for PN. Patients were divided into two groups: guidance compliant and guidance non-compliant. Primary outcome measures were duration of PN treatment, number of PN bags used per patient, length of hospital stay and mortality.


RESULTS
There were 262 patients, aged 54(42-67) [median (IQR)] years. The guidance compliant and the non-compliant groups consisted of 143 and 119 patients respectively. In the guidance compliant group all patients were screened on admission compared to 40% in the non-compliant group (p < 0.001). Among those malnourished/at risk of malnutrition all were referred for early dietetic assessment in the compliant group but only 14% in the non-compliant group (p < 0.001). There was no difference in any of the outcome measures between the groups.


CONCLUSIONS
Compliance with the nutritional guidance in the UK was not enough to improve outcomes in patients requiring PN in our cohort. Evidence based changes to PN practice are required to optimise care.
Department of Chemical Pathology, King's College Hospital NHS Foundation Trust, Denmark Hill, London SE5 9RS, UK. royce.vincent@nhs.net
Royce P
RP
Vincent
Sohail
S
Omar
Manal O
MO
Elnenaei
Chui Hoong
CH
Goo
Rashim
R
Salota
PeiFang
P
Wu
Hannah L
HL
Delaney
Carel W
CW
le Roux
D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003955:Diagnostic Tests, Routine; D005260:Female; D019983:Guideline Adherence; D006785:Hospitals, University; D006801:Humans; D007902:Length of Stay; D008297:Male; D044342:Malnutrition / Q000175:diagnosis* / Q000453:epidemiology / Q000401:mortality / Q000628:therapy; D008875:Middle Aged; D009026:Mortality; D009313:National Health Programs; D015596:Nutrition Assessment; D010288:Parenteral Nutrition / Q000009:adverse effects; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D012017:Referral and Consultation; D012306:Risk; D006113:United Kingdom / Q000453:epidemiology