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The decision to start PN was made by a doctor or doctor and dietician in 91% of cases (table 1).Only 28% of the clinicians making the decision to start PN were a member of a multidisciplinary nutrition team.Objectives Parenteral nutrition (PN) is widely used to provide nutritional support to patients with inaccessible or inadequate length of gut or non-functioning gut.
The types of admission were emergency admission 76.0%, planned/elective 19.3%, inter-hospital transfer 2.6% and unknown in 2.1%.
A data collection tool was designed by the NNN based on the recommendations from the recent NCEPOD report (see online supplementary data) collecting information on five aspects of PN care: patient and admission details, indication for PN, patient assessment, venous access/line care and metabolic complications.
Our tool was slightly simplified from that used in the NCEPOD report in order to maximise participation in the audit with less focus on the location of the patient.
The importance of multidisciplinary nutrition support teams has been described.1 There are national and international (ESPEN; European Society for Clinical Nutrition and Metabolism) guidelines for nutritional support in adults.2–7 The American Society for Parenteral and Enteral Nutrition (ASPEN) has recently highlighted the need for frameworks to guide institutions in developing and maintaining competencies for safe PN due to its complexity and likely increasing use of this feeding route.8In 2010, there was a UK National Confidential Enquiry into Patient Outcome and Death (NCEPOD) report focused on PN, ‘A Mixed Bag’.9 The primary aim of the study was to examine the process of care of patients receiving PN in hospital in order to identify remediable factors in the care received by these patients.
There were six main themes in the report: indication for PN, type of PN, PN prescribing, catheter choice, insertion and care, complications and nutrition teams.
The NNN has previous experience of conducting region-wide audits with high response rates.10The aim of this study was to compare practice in the administration of PN in hospitals in the North of England to results of the recent NCEPOD study and whether there had been any improvements in care since that audit.