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Published on: September 20, 2019
Laboratory Monitoring of Children on Home Parenteral Nutrition: A Prospective Study
Amber Smith1, Mary Beth Feuling1, Catherine Larson-Nath2
1Children's Hospital of Wisconsin, Milwaukee, Wisconsin, USA.
Insights
A multidisciplinary team approach to home parenteral nutrition (PN) laboratory monitoring significantly reduces costs and lab draws. This protocol improves patient safety by preventing nutrition deficiencies and simplifying PN management.
Area of Science:
- Clinical Nutrition
- Patient Safety
- Healthcare Management
Background:
- Home parenteral nutrition (PN) requires careful laboratory monitoring to ensure patient safety and prevent deficiencies.
- Current monitoring protocols may not be optimized for efficiency or cost-effectiveness.
- An interdisciplinary team approach is hypothesized to improve PN management.
Purpose of the Study:
- To evaluate the impact of a protocolized, team-based laboratory monitoring schedule for home PN patients.
- To assess improvements in patient safety, specifically regarding nutrition deficiencies.
- To determine the cost-effectiveness of the protocolized monitoring approach.
Main Methods:
- A prospective cohort study involving home PN patients.
- Implementation of an established protocol for laboratory monitoring and weekly interdisciplinary team review (dietitians, nurses, physicians).
- Collection of data on anthropometrics, lab results, protocol deviations, laboratory charges, and PN formulation shortages.
Main Results:
- Fifteen pediatric patients with short bowel syndrome or intestinal pseudo-obstruction were included.
- A significant reduction in median lab draws per patient per month (2.9 pre-protocol vs. 1.14 post-protocol).
- A significant decrease in median monthly laboratory charges per patient ($2014 pre-protocol vs. $792 post-protocol).
Conclusions:
- A structured, team-based approach simplifies home PN management.
- Protocolized laboratory monitoring significantly decreases costs and the number of laboratory draws.
- This approach enhances micronutrient monitoring, prevents deficiencies, and improves overall patient safety.
Background:
The primary hypothesis of this article is that a team approach in creating a protocolized laboratory monitoring schedule for home parenteral nutrition (PN) patients improves patient safety by decreasing the occurrence of nutrition deficiencies and is cost-effective.
Methods:
In this prospective cohort study of home PN patients, each patient followed an established protocol of laboratory monitoring and weekly review by an interdisciplinary team of dietitians, nurses, and physicians. Data collected included anthropometric measurements, laboratory results, deviations from laboratory protocols, laboratory charges, PN shortage information, and means of ameliorating such shortages. Cost-effectiveness analysis was only performed for nonmicronutrient laboratory tests.
Results:
Fifteen children (male, n = 6) with a median age of 59 months (range, 19-216) were included in this study. Primary diagnoses included short bowel syndrome (47%) and intestinal pseudo-obstruction (40%). Patients received PN mixtures from 6 different infusion companies and experienced 60 different shortages in the PN formulation requiring adjustments or substitutions (mean, 4 shortages per patient). All patients had appropriate growth and complete micronutrient monitoring. No patient experienced any clinical symptoms due to shortages. The median number of laboratory draws/patient per month was 2.9 preprotocol compared with 1.14 postprotocol (P = .003). The median per patient per month charges were $2014 (interquartile range [IQR], 1471-2780) preprotocol compared with $792 (IQR, 435-1140) postprotocol (P = .002).
Conclusions:
A structured team approach to laboratory monitoring of home PN patients can simplify PN management, significantly decrease monthly laboratory costs, and lead to fewer laboratory draws while improving micronutrient monitoring and preventing deficiencies.
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