Assessing the Impact of Registered Dietitian Recommendations on the Appropriate Use of Parenteral Nutrition in a Community Hospital Setting

Introduction: Parenteral Nutrition (PN) can be a beneficial supplementation option when used in the appropriate clinical setting. A nutrition support team (NST) has been demonstrated to reduce the inappropriate use of PN, however less than half of community hospitals in the United States have adopted this model. Our study aimed to evaluate PN usage in a community hospital setting in the absence of a NST. The implementation of a hospital policy requiring a registered dietician consultation prior to the initiation of PN allowed us to assess the impact of this method on PN usage patterns. Methods: A retrospective chart review was conducted at Riverside medical center Kankakee comparing 2 different 9 month time periods. The first time period, February 1, 2012 to October 31, 2012, was preceding the implementation of a hospital policy requiring a registered dietician consultation prior to the initiation of parenteral nutrition. The second time period, December 1, 2012 to August 31, 2013, was after this policy was implemented. One month (November 2012) between these two time periods was excluded from data collection and acted as a wash out period to allow for implementation of this policy. Data was collected on the indication and duration of PN. PN indications were assessed as appropriate or inappropriate based on current ASPEN guidelines. Results: A total of 196 patients were included in this study: 109 prior to policy implementation and 87 after. After policy implementation a decline in the proportion of hospitalized patients receiving PN was observed, however this was not statistically significant (1.52% vs. 1.31%; z=1.04; p-value=0.298, Fisher’s exact test: p-value=0.314). A reduction in inappropriate PN usage was observed after policy implementation, however this reduction was not statistically significant (67% vs. 65.5%, z=0.21 and p-value=0.831). However, a significant reduction in PN duration was observed after policy implementation (8.33 vs. 6.47 (days), t-value=2.40 and p-value=0.017). Conclusion: In a community hospital setting, a policy requiring a registered dietician consultation prior to initiation of PN did not result in a significant decline in the percentage of patients receiving PN or the inappropriate use of PN. This requirement however did result in a significant reduction in the duration for which patients received PN. Additional methods or policies are needed to reduce the inappropriate usage of PN in our community hospital.