Home parenteral nutrition: safe transition from hospital to home

Parenteral nutrition (PN) is a complex therapy that may result in serious harm if not properly prescribed, prepared, and administered. The patient who is discharged home on PN for the first time poses significant safety challenges and requires coordination of care between several healthcare disciplines within and outside the hospital. Use of an experienced prescriber and multidisciplinary team to oversee the home PN therapy is an important measure to optimize safety. Referrals should be made to home health and home infusion agencies with qualified staff; however, this may at times be difficult to assess. A safe discharge also requires transition of care between inpatient clinicians caring for the patient and designated outpatient follow-up. Home PN and lab orders upon discharge should be clear and comprehensive. The use of a standardized home PN order format is an important measure to ensure accuracy of the order. Patient and/or caregiver education is another vital component to safely providing PN in the home setting and should ideally be initiated prior to discharge. This should include instructions to the patient regarding self-monitoring and when to call if problems develop. Specific criteria should be identified for the patients regarding when and who to contact for problems that develop after they are discharged home.