title: Quality and safety impact on the provision of parenteral nutrition through introduction of a nutrition support team.
abstract: OBJECTIVE
  Parenteral nutrition (PN) should be provided to the malnourished patient if enteral feeding is insufficient or unsafe. A nutrition support team (NST) may improve PN services. We compared the use and complications of hospital PN before and after the implementation of an NST.
  
  
  METHODS
  All inpatients referred for PN outside of the intensive care unit and the intestinal failure unit were prospectively included from 2009 to 2012. The NST was introduced in 2010. Quality improvement methodology was applied.
  
  
  RESULTS
  In 2009, a mean of 16 (limits of normal variation 4-28) patients were referred for PN each month. After introduction of the NST, this rose to 26 (10-42) referrals per month. The percentage of referrals where PN was not initiated increased from 5.3% in 2009 to 10.1% in 2012 (P=0.03). This increase was restricted to teams that infrequently referred for PN, and enteral nutrition could replace PN in 31 of 51 patients (61%) as compared with 8 of 32 (25%) patients referred from teams that frequently referred for PN (P=0.001). The frequency of PN started owing to an insufficient oral or enteral intake decreased from 11% to 3% (P=0.01). The catheter-related bloodstream infection rate dropped from 6.7 to 0.7 episodes per 1000 catheter days (P<0.001).
  
  
  CONCLUSIONS
  Introduction of an NST increased both the total PN use and the percentage of referrals where enteral nutrition could replace PN. Medical specialty influenced the referral pattern and the likelihood that a referral resulted in PN being initiated. Safety of PN catheters improved significantly following NST introduction.
authors.affiliation: 1] Intestinal Failure Unit, Salford Royal NHS Foundation Trust, Manchester, UK [2] Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus C, Denmark.
authors.forename: C L
authors.initials: CL
authors.lastname: Hvas
authors.affiliation: Intestinal Failure Unit, Salford Royal NHS Foundation Trust, Manchester, UK.
authors.forename: K
authors.initials: K
authors.lastname: Farrer
authors.affiliation: Quality Improvement Directorate, Salford Royal NHS Foundation Trust, Manchester, UK.
authors.forename: E
authors.initials: E
authors.lastname: Donaldson
authors.affiliation: Nutrition Support Team, Salford Royal NHS Foundation Trust, Manchester, UK.
authors.forename: B
authors.initials: B
authors.lastname: Blackett
authors.affiliation: Nutrition Support Team, Salford Royal NHS Foundation Trust, Manchester, UK.
authors.forename: H
authors.initials: H
authors.lastname: Lloyd
authors.affiliation: Nutrition Support Team, Salford Royal NHS Foundation Trust, Manchester, UK.
authors.forename: C
authors.initials: C
authors.lastname: Forde
authors.affiliation: Inpatient Pharmacy, Salford Royal NHS Foundation Trust, Manchester, UK.
authors.forename: G
authors.initials: G
authors.lastname: Garside
authors.affiliation: 1] Nutrition Support Team, Salford Royal NHS Foundation Trust, Manchester, UK [2] Department of Gastroenterology, Salford Royal NHS Foundation Trust, Manchester, UK.
authors.forename: P
authors.initials: P
authors.lastname: Paine
authors.affiliation: 1] Intestinal Failure Unit, Salford Royal NHS Foundation Trust, Manchester, UK [2] Nutrition Support Team, Salford Royal NHS Foundation Trust, Manchester, UK [3] Department of Gastroenterology, Salford Royal NHS Foundation Trust, Manchester, UK.
authors.forename: S
authors.initials: S
authors.lastname: Lal
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D006801:Humans; D044342:Malnutrition / Q000401:mortality / Q000628:therapy*; D008875:Middle Aged; D010288:Parenteral Nutrition / Q000009:adverse effects / Q000379:methods* / Q000592:standards; D011446:Prospective Studies; D012017:Referral and Consultation; D018805:Sepsis / Q000209:etiology; D006113:United Kingdom