National clinical guidelines and home parenteral nutrition

Research-based guidelines provide the best evidence and are the cornerstones of achieving quality outcomes for home parenteral nutrition (HPN) patients and their families. However, evidence about the implementation of HPN guideline recommendations is rarely reported. The purpose of this clinical practice project was to compare HPN clinical guidelines with baseline data reported by HPN patients from 1990-2010 and to explore possible facilitators or barriers to the implementation of guidelines in clinical practice. Methods included PubMed literature searches for HPN clinical guidelines and comparison of the retrieved guidelines with HPN clinical data reported by HPN patients from 3 separate studies conducted in the United States from 1990-2010. Results of reviewing published HPN guidelines found recommendations based primarily on expert opinion and included the appropriate use of HPN, coordination of care by teams of experts, use of dedicated ports, salvaging catheters when possible, and bowel transplantation. Comparison of baseline data over the 2 decades indicated that guidelines for the appropriate use and types of central venous catheters were being implemented, but there was little evidence that most HPN patients had their care coordinated by multidisciplinary teams. Conclusions are that most HPN guideline recommendations were being implemented in practice except for the care delivered by multidisciplinary experts. To ensure quality HPN outcomes, multidisciplinary teams of HPN experts are needed as are large data sets that will provide indicators of guideline use and outcomes. Furthermore, research is needed so that recommendations are not based totally on expert consensus.