Concurrent quality assurance for a nutrition-support service

Area of Science:

• Pharmacy Practice
• Quality Improvement
• Clinical Nutrition

Background:

• Nutrition Support Services (NSS) are crucial in hospitals, often managing complex therapies like total parenteral nutrition (TPN).
• Implementing robust quality assurance (QA) programs is essential for optimizing patient care and resource management within NSS.

Purpose of the Study:

• To describe the development and implementation of a pharmacy-based QA program for an NSS.
• To monitor key indicators related to TPN therapy, including indications, complications, nutritional outcomes, and wastage.

Main Methods:

• A multidisciplinary planning group developed a QA program with four indicator categories: discretionary, complications, nutritional outcomes, and miscellaneous.
• A TPN monitoring checklist and defined standards were created for daily evaluation, weekly reviews, and monthly reporting.
• Data from 248 patients over six months (starting January 1, 1988) were compiled and analyzed.

Main Results:

• Noncompliance was rare for discretionary indicators and septic complications.
• Most metabolic complication indicators met standards, while nutritional outcomes generally exceeded standards, except for nitrogen balance.
• TPN wastage exceeded standards for four months, and missing laboratory data prompted form revisions.

Conclusions:

• The pharmacy-led QA program provided valuable daily, weekly, and monthly insights into NSS performance.
• The program successfully identified areas needing attention, such as TPN wastage and laboratory data completeness.
• The QA program facilitated adaptive standard setting, enhancing the overall quality of nutrition support.