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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 rai...
Autores principales: | , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
John Wiley and Sons Inc.
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10084298/ https://www.ncbi.nlm.nih.gov/pubmed/35499296 http://dx.doi.org/10.1002/ncp.10856 |
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author | Busch, Rebecca A. Stone, Susan Kudsk, Kenneth A. |
author_facet | Busch, Rebecca A. Stone, Susan Kudsk, Kenneth A. |
author_sort | Busch, Rebecca A. |
collection | PubMed |
description | 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. |
format | Online Article Text |
id | pubmed-10084298 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | John Wiley and Sons Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-100842982023-04-11 A tale of two analyses: Administrative vs primary review of nutrition support team performance Busch, Rebecca A. Stone, Susan Kudsk, Kenneth A. Nutr Clin Pract Clinical Research 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. John Wiley and Sons Inc. 2022-05-02 2023-02 /pmc/articles/PMC10084298/ /pubmed/35499296 http://dx.doi.org/10.1002/ncp.10856 Text en © 2022 The Authors. Nutrition in Clinical Practice published by Wiley Periodicals LLC on behalf of American Society for Parenteral and Enteral Nutrition. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ (https://creativecommons.org/licenses/by-nc-nd/4.0/) License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made. |
spellingShingle | Clinical Research Busch, Rebecca A. Stone, Susan Kudsk, Kenneth A. A tale of two analyses: Administrative vs primary review of nutrition support team performance |
title | A tale of two analyses: Administrative vs primary review of nutrition support team performance |
title_full | A tale of two analyses: Administrative vs primary review of nutrition support team performance |
title_fullStr | A tale of two analyses: Administrative vs primary review of nutrition support team performance |
title_full_unstemmed | A tale of two analyses: Administrative vs primary review of nutrition support team performance |
title_short | A tale of two analyses: Administrative vs primary review of nutrition support team performance |
title_sort | tale of two analyses: administrative vs primary review of nutrition support team performance |
topic | Clinical Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10084298/ https://www.ncbi.nlm.nih.gov/pubmed/35499296 http://dx.doi.org/10.1002/ncp.10856 |
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