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Conclusions This region-wide prospective audit suggests improved practice within the UK compared to the NCEPOD audit with lower mortality and line sepsis rates. This work strengthens the case for introducing nutrition teams in hospitals without this service.
These findings are likely to be reproduced across the UK and in other healthcare settings.
The importance of multidisciplinary nutrition support teams has been described.1 There are national and international (ESPEN; European Society for Clinical Nutrition and Metabolism) guidelines for nutritional support in adults.2–7 The American Society for Parenteral and Enteral Nutrition (ASPEN) has recently highlighted the need for frameworks to guide institutions in developing and maintaining competencies for safe PN due to its complexity and likely increasing use of this feeding route.8In 2010, there was a UK National Confidential Enquiry into Patient Outcome and Death (NCEPOD) report focused on PN, ‘A Mixed Bag’.9 The primary aim of the study was to examine the process of care of patients receiving PN in hospital in order to identify remediable factors in the care received by these patients.
There were six main themes in the report: indication for PN, type of PN, PN prescribing, catheter choice, insertion and care, complications and nutrition teams.
Our findings are likely to be similar to those in different parts of the UK and other healthcare settings and may provide a template for other prospective audits of care.
The types of admission were emergency admission 76.0%, planned/elective 19.3%, inter-hospital transfer 2.6% and unknown in 2.1%.This report has focused attention on the in-hospital use of PN within all parts of the UK.The Northern Nutrition Network (NNN) was established in 2003 and is a collaboration of North East-based multidisciplinary nutrition teams, including physicians, surgeons, dieticians, nurses, pharmacists and biochemists, consisting of nine acute trusts including North Cumbria.The NNN has previous experience of conducting region-wide audits with high response rates.10The aim of this study was to compare practice in the administration of PN in hospitals in the North of England to results of the recent NCEPOD study and whether there had been any improvements in care since that audit.The hospitals in our region serve a population of ∼2.7 million people.
‘A Mixed Bag’ found that only 19% of adult patients who had PN care considered to represent good practice.