Concurrent quality assurance for a nutrition-support service

A pharmacy-based quality assurance program for a nutrition support service (NSS) is described. The NSS, located in a university teaching hospital, is consulted to provide nutritional therapies, primarily total parenteral nutrition (TPN). A planning group from the NSS developed a quality assurance program to monitor specific activities of the service. Four categories of indicators were selected: discretionary, including the indication for TPN and length of TPN therapy; complications, including metabolic, septic, and mechanical; nutritional outcomes, such as nitrogen balance determinations and visceral protein status; and miscellaneous, such as frequency of missing nutrition-related laboratory data. The planning group developed a TPN monitoring checklist that defined the absolute ranges acceptable for each monitored laboratory test, and standards for each indicator were developed. The program was designed to allow daily evaluation, provide weekly reviews, and generate monthly reports on quality assurance issues. The TPN monitoring checklist was incorporated into the daily monitoring form. Data were compiled from 248 patients over a six-month period beginning on January 1, 1988. Noncompliance with standards was rare for discretionary indicators. A majority of indicators of metabolic complications were in compliance with the standards, as were all indicators of septic complications. Both indicators of nutritional outcome were above the standard, except nitrogen balance during months 4 and 5. The TPN wastage rate was noncompliant with standards during four of the six months. Missing TPN laboratory data (n = 94) in January prompted identification of individual laboratories on the TPN order form. If the mean percentage compliance during this six-month period was higher than the initial standard, then the standard was upgraded.(ABSTRACT TRUNCATED AT 250 WORDS)