Total parenteral nutrition: a four-year audit

Area of Science:

• Clinical Nutrition
• Hospital Auditing
• Patient Outcomes

Background:

• Total parenteral nutrition (TPN) is a critical intervention for patients unable to receive enteral nutrition.
• Auditing TPN practices is essential for identifying areas of improvement in patient care and resource utilization.
• Saudi Arabian hospitals face unique challenges in managing complex nutritional support.

Purpose of the Study:

• To conduct a comprehensive audit of total parenteral nutrition (TPN) practices over a four-year period.
• To evaluate patient outcomes, including mortality, nutritional status, and complication rates associated with TPN.
• To identify areas for protocol and staffing adjustments to optimize TPN delivery.

Main Methods:

• A retrospective audit of 278 patients receiving 289 TPN courses over 5213 patient days.
• Data collection included patient demographics, TPN duration, clinical outcomes, and complications.
• Analysis of mortality rates, nutritional status changes, and incidence of metabolic and infectious complications.

Main Results:

• Overall mortality was 36%, with 53% mortality in ICU patients.
• 74.8% of survivors demonstrated improved nutritional status.
• Incidences of metabolic complications and catheter sepsis were low at 2.9% and 3.6%, respectively.

Conclusions:

• TPN is associated with significant mortality, particularly in critically ill patients.
• Despite challenges, TPN can lead to improved nutritional status in a majority of survivors.
• Audit findings have informed changes in TPN protocols and patient selection to enhance care quality.