title: Assessing appropriateness of parenteral nutrition usage in an acute hospital.
abstract: BACKGROUND
  Although parenteral nutrition (PN) has become an integral component of patient care, the risks and costs associated with this therapy must be weighed against the benefits. The Department of Nutrition and Dietetics at our tertiary referral, university-affiliated hospital has audited the use of enteral nutrition and PN based on criteria devised from guidelines developed by the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.). We aimed to examine the use of PN over time and in particular to investigate the appropriate and inappropriate use of this feeding method.
  
  
  METHODS
  Each patient referred for PN was assessed by a dietitian and need for PN evaluated. The appropriateness of the PN was categorized according to predefined criteria.
  
  
  RESULTS
  A total of 1191 patients had 1409 episodes of PN during the study period. According to the predefined criteria, 82% of PN episodes were considered "appropriate." PN was "appropriate but avoidable" in 13% of cases. In 5% of episodes, the commencement of PN was considered "inappropriate." The use of appropriate PN increased significantly over the study period (P = .018).
  
  
  CONCLUSIONS
  Most PN episodes were deemed appropriate. We saw 5% inappropriate usage, which is lower than reported in comparable studies. This study underlines the importance of continuous audit and evaluation of practice to maintain appropriate and evidence-based practice in nutrition support.
authors.affiliation: Tallaght Hospital, Dublin, Ireland. niamh.smyth@amnch.ie
authors.forename: Niamh D
authors.initials: ND
authors.lastname: Smyth
authors.forename: Elaine
authors.initials: E
authors.lastname: Neary
authors.forename: Siobhan
authors.initials: S
authors.lastname: Power
authors.forename: Sinead
authors.initials: S
authors.lastname: Feehan
authors.forename: Sinead N
authors.initials: SN
authors.lastname: Duggan
mesh_terms: D003362:Cost-Benefit Analysis; D004046:Dietetics / Q000379:methods / Q000592:standards; D019983:Guideline Adherence; D006761:Hospitals; D006801:Humans; D008485:Medical Audit; D010288:Parenteral Nutrition / Q000706:statistics & numerical data; D005791:Patient Care / Q000592:standards*; D017410:Practice Guidelines as Topic; D012017:Referral and Consultation; D012955:Societies, Medical