Introduction: The evidence-based standard for optimal nutritional support is the Multidisciplinary team (MDT) approach of a Nutrition Support Team (NST). Our hospital team was established in 2015 after a 3 year pilot 2012-2014. The nurse-led team review new parenteral nutrition (PN) referrals and continue to visit assess and advice twice weekly. The aims of the team are to:

• Improve the safety and adequacy of PN delivery to patients
• Provide high quality nutritional outcomes via enteral and PN
• Deliver significant cost savings
• Improve hospital wide nutrition education (nursing, medical and allied health professional )

Aim: To assess improvements in clinical care and financial benefits associated with the NST before and after the service was established looking at:

1) PN bag usage

2) Standard bag usage

4) Wastage

Method: The PN usage pre and post the NST was collected from a pharmacy database. A new NST database collected prospective data on the activity of the team. Data collected included: clinical speciality, recommendations, abnormal blood results, time on PN and refeeding risk. This data was analysed as part of this audit process.

Results:

There has been a 20% reduction in the number of total PN bags/year (fig 1).

Standard bag usage increased from 6% to 30% between 2012 and 2018 (fig 2) .

Reduction in PN usage and increased % of standard bags has reduced cost of PN provision between 2012 and 2018 by approximately €230,000/year.

Wastage of PN bags reduced from 4% to 3.7% between 2012 and 2018. Reasons for wastage include full enteral nutrition, patient deceased and transfer to another hospital.

NST recommendations for changes in PN prescribing and monitoring were made in 70% of contacts in a 12 month period.

57 patients in a 12 month period were considered at risk of refeeding, 56% of patients showed metabolic signs of refeeding and their plan of care was adjusted accordingly. There were no cases of unanticipated refeeding.

Conclusion: Regular patient reviews, forward planning and education has improved the safety of PN delivery, decreased the total number of PN bags used and contributed to increased standard bag usage. Choosing other available standard bags to suit our population of patients has also been a contributory factor for this significant increase.

Wastage of PN has shown a modest decrease during the study period. Anticipating weaning of PN and patient transfer is an area of focus for the team.