Assessing Appropriate Parenteral Nutrition Ordering Practices in Tertiary Care Centers

Dr. Mark DeLegge and colleagues published in the January/February issue of the Journal of Parenteral and Enteral Nutrition an article titled “Assessing appropriate parenteral nutrition ordering practices in tertiary care centers.” This article and the research were partially funded by the South Carolina Research Consortium and the South Carolina Research Authority.

Parenteral nutrition is frequently used in the hospital environment because of “gut dysfunction.” However, parenteral nutrition requires a central venous catheter for infusion and strict monitoring of the patient’s metabolic status. Associated complications include bacteremia, sepsis, thromboembolic disease and liver failure. With that, it is recommended to start enteral nutrition (tube feeding) as opposed to parenteral nutrition if possible. Specific guidelines exist that recommend when parenteral nutrition is appropriate. One of these guidelines is published by the American Society of Parenteral and Enteral Nutrition.

This article described a study at four major South Carolina hospital systems. Over a three-month period, trained dietitians collected data on the appropriate ordering of parenteral nutrition at their facilities as determined by the American Society of Parenteral and Enteral Nutrition guidelines. It was noted that PN was inappropriately prescribed in 32% of the cases examined in the South Carolina facilities resulting in 552 days of inappropriate PN therapy at a cost of $138,000. This is consistent with data collected at an individual academic center in South Carolina that was reported in early 2000. If an institution had a nutrition support team that was actively participating in patient care, they had reported less inappropriate PN use. In addition, if an institution employed more certified nutrition support dietitians, they also had less inappropriate PN use.

Parenteral nutrition is a life-saving therapy. Its use can be extraordinarily beneficial. However, there are also risks and costs to the therapy that need to be considered. Appropriate use of parenteral nutrition therapy is imperative to improving clinical outcomes.

Dr. Mark DeLegge is the Director of the Nutrition Support Team and the Director of Nutrition at the Medical University of South Carolina. He is board certified in nutrition, gastroenterology and internal medicine. He has been a member of the American Society of Parenteral and Enteral Nutrition since 1989 and serves on their board of directors.