A tale of two analyses: Administrative vs primary review of nutrition support team performance

BACKGROUND: Our pharmacy department performed a medication‐use evaluation using administrative data to assess prescription of parenteral nutrition (PN). They found that 31.6% (185 of 586) of nutrition support team (NST) patients received ≤5 days of PN, whereas 120 received ≤3 days. These results raised the question of NST prescribing practices given the incidence of short‐duration PN. Since our NST evaluates all PN requests, the study prompted further review to identify reasons for short duration PN. METHODS: Charts of patients receiving PN for ≤3 days in the initial study underwent an in‐depth review focusing on indications, reasons for discontinuation, and protein‐calorie malnutrition (PCM) at time of NST consultation. RESULTS: A total 120 of 586 patients had PN ≤3 days. PN was clearly indicated in 94 cases: 27 patients received home PN but resolved the need for admission, 11 were admitted to later discharge on PN, 18 chose alternative/palliative care soon after starting PN, and 38 were nil per os for ≥6 days because of ileus, bowel obstruction, or contraindication to enteral feeding. Of the remaining 26 patients, 15 had PCM with poor intake for ≥ 3 days, warranting PN; only nine cases had unclear indications for PN and 11 could have potentially been avoided. CONCLUSION: Administrative data implied inappropriate PN use, whereas in‐depth review confirmed appropriate prescription in most patients. Reducing short‐duration PN in the management of ileus or obstruction remains difficult because of variable time to symptom resolution. In‐depth chart review remains the best method to assess appropriateness of PN use.