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Jacobson, K.1; Boctor, D. L.2; Homenuk, S.3; Tsang, G.3; Hamilton, D. P.3; Taha, F.4

Journal of Pediatric Gastroenterology and Nutrition: June 2004 - Volume 39 - Issue - p S19
ABSTRACTS: Oral Presentation Abstracts

1Pediatrics, British Columbia’s Children’s Hospital,2Pediatrics,3Pharmacy,4Decision support, British Columbia’s Chidlren’s Hospital, Vancouver, Canada

Submitted by:

Introduction: Previous studies have demonstrated the value of nutrition support teams (NST) in patient care, quality control issues and possibly in hospital cost savings. Despite this, the majority of tertiary pediatric centres in Canada do not have nutrition support teams. The purpose of this study was to determine the appropriateness of parenteral nutrition (PN) utilization in non-acute hospital areas in the absence of a nutrition support team. When compared to standards of care, this data was used to estimate potential cost avoidance.

Methods: This observational survey included all patients between the ages of 0–18 years on 3 general paediatric and surgical wards admitted between March-June 2002. Fifteen out of 120 patients admitted and placed on PN by the attending physicians were included. The medical conditions were as follows: inflammatory bowel disease (n=6), cystic fibrosis (n=3), pancreatic trauma (n=2), duodenal atresia (n=1), hirschsprung’s disease (n=1), paralytic ileus (n=1) and proximal small bowel obstruction (n=1).

Results: A total of 160 patient days of PN was analyzed. Thirty three percent of patients failed to receive an appropriate nutritional assessment prior to initiation of PN including, weight, height, estimation of nutrient requirements and assessment of biochemical indices of nutritional status. Only 53% of patients received a baseline nutritional assessment by both physician and dietitian. Enteral nutrition could have been utilized over parenteral nutrition in 53% of the cases. This represented an additional cost of CDN$115 /patient/day not including differential labour costs. Only 27% of patients were started on an age-appropriate macronutrient profile and 33% had safe progression of macronu-trients. The majority of patients did not have calorie counts done either at baseline or during transition to enteral feeds (87%) thus preventing the determination of appropriate caloric achievement. It was estimated that 21% of the PN days could have been avoided had PN therapy been more appropriately initiated and discontinued.

Conclusion: This observational study demonstrates that the selection of patients eligible for PN, its initiation, progression and discontinuation could be further optimized to achieve nutritional goals. Moreover, this study suggests that the more appropriate prescription of PN by a dedicated NST would improve the standard of patient care and may have costs saving benefits. Future efforts should focus on such implementation in pediatric tertiary care centres.

© 2004 Lippincott Williams & Wilkins, Inc.