Quality control of parenteral nutrition in hospitalized patients

For hospitalized patients requiring parenteral nutrition (PN), adequate nutritional support has a profound effect on hospital length of stay, morbidity, mortality, and complication rates. Inappropriate or inadequate nutritional therapy may worsen clinical outcome. The aim of this study was to investigate the compliance with nutritional guidelines for PN in a university hospital setting.

Over a 6-mo period, this monocentric study prospectively recruited 107 (41 women, 66 men) hospitalized medical and surgical patients requiring PN. Data on nutritional support were collected before nutritional counseling. Nutritional requirements were estimated on the basis of the European Society for Clinical Nutrition and Metabolism (ESPEN) Guidelines for Adult Parenteral Nutrition (2009).

The mean patient age was 65 ± 1.4 y and the mean body mass index was 23.2 ± 0.5 kg/m². Only 75% of the caloric requirement was met. Multivitamin supplementation was adequate in only 37%, and for vitamin K in only 6% of cases. Trace element supplementation was adequate in only 35%. PN in complete agreement with the ESPEN guidelines was achieved in none of the patients.

In routine hospital practice, PN is generally not provided in compliance with established guidelines. To improve the quality of nutritional therapy, a nutritional support team should be established. Furthermore, there should be periodical training sessions in nutrition for medical and nursing staff, as well as in standard operating procedures.