A protocol for sustained reduction of Total Parenteral Nutrition and cost savings by improvement of nutritional care in hospitals

Clinical Nutrition ESPEN
Rian van SchaikTheo A Niewold

Abstract

Malnutrition and the use of Total Parenteral Nutrition (TPN) contribute considerably to hospital costs. Recently, we reported on the introduction of malnutrition screening and monitoring of TPN use in our hospital, which resulted in a large (40%) reduction in TPN and improved quality of nutritional care in two years (2011/12). Here, we aimed to assure continuation of improved care by developing a detailed malnutrition screening and TPN use protocol involving instruction tools for hospital staff, while monitoring the results in the following two years (2013/14). A TPN decision tree for follow up of TPN in patients and a TP-EN instruction card for caregivers was introduced, showing TPN/EN introduction schedules based on the energy needs of patients according to EB guidelines, also addressing the risk of refeeding syndrome. TPN patients were monitored by dietitians and TPN usage and costs were presented to the (medical) staff. Screening and treatment of malnourished patients by dietitians is simultaneously ongoing. In 2014 48% of patients, hospitalized for at least 48 h, were screened on malnutrition, 17% of them were diagnosed at risk, 7.9% malnourished and treated by dietitians. TPN usage dropped by 53% and cost savings of 51% w...Continue Reading

Citations

Mar 18, 2020·JPEN. Journal of Parenteral and Enteral Nutrition·Patriek Mistiaen, Koen Van den Heede
Nov 26, 2020·JPEN. Journal of Parenteral and Enteral Nutrition·Heather H KellerManon Laporte

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