Improving the safety and effectiveness of parenteral nutrition: results of a quality improvement collaboration.

Parenteral nutrition (PN) is a high-risk nutrition support modality. This article describes the approach taken by 1 hospital to improve safety and quality of this therapy as well as the challenges and obstacles to success. Process improvement strategies included revisions to the PN order form, education of clinicians (including physicians), increased collaboration between pharmacists and registered dietitians, and initiation of PN rounds during which PN patients were reviewed by the rounding team twice weekly. These strategies were spearheaded by clinicians with advanced certifications in nutrition support. These process changes positively impacted quality and costs. Comparison of baseline and follow-up data showed improvement in compliance to mandatory safe practice standards, percentage of patients with appropriate indication for PN, adequote glycemic management, number of patients receiving PN within 10% of calorie needs, and appropriate laboratory monitoring. In addition to quality improvement, substantial cost savings were realized through decreased inappropriate PN use and timely transition to oral or enteral feeding. The average number of patients receiving PN decreased from approximately 15 to less than 5 per day. Overall, this translated into a $5.3 million decrease in PN charges. Actual pharmacy expenses decreased by $107,000. This quality improvement project demonstrated that implementing practice guidelines published by the American Society for Parental and Enteral Nutrition can result in quality improvement and cost savings. Clinicians with advanced certifications in nutrition support were pivotal to the success of the project.