A LOCAL REVIEW OF THE NCEPOD AUDIT OF PARENTERAL NUTRITION - WHAT CAUSED THE 'MIXED BAG'?

IntroductionThe report, “A Mixed Bag”, published by NCEPOD in 2010 was a review of Parenteral Nutrition (PN) in hospitalised patients. It demonstrated that only 19% of adults received care deemed to represent good clinical practice. Particular attention was drawn to poor documentation of nutritional issues.Aims/BackgroundTo audit the administration of Parenteral Nutrition within the RVH, Belfast in direct comparison with NCEPOD report and to identify where discrepancies existed.MethodConsecutive patients started on PN at the time of the NCEPOD report were identified using pharmacy records. Each patient9s medical, dietetic and nutrition nursing notes were independently reviewed using the NCEPOD PN Questionnaire.Results27 patients were identified with patients excluded due to missing casenotes. No treatment goal was documented for 89% of patients. Twelve percent of patients had PN started at a weekend, refeeding risk was not documented for these patients but was for all others. The initial bag was inappropriate for patient needs in 17%, the majority of these started at the weekend. While combining records revealed good clinical monitoring, this was poor in medical notes compared with dietetic/nursing records. Metabolic complications occurred in 39%, similar to NCEPOD. There was a universal lack of documentation regarding central venous catheter insertion.ConclusionOur audit reiterates the findings of the NCEPOD report, with particular regard to documentation and complications. Patients started at the weekend appeared to have poorer documentation. The development of a PN proforma or clinical check list may be useful to identify and reduce risks/complications.