BSNA Parenteral Nutrition Survey GAINING AN INSIGHT INTO HEALTHCARE PROFESSIONALS’ VIEWS ON PARENTERAL NUTRITION
What is Parenteral Nutrition? Parenteral nutrition is administered to improve the nutritional status of a patient • Parenteral nutrition (PN) is the provision of nutrients and fluid to a patient by an intravenous route. • PN is a complex and well established form of artificial nutrition support. It may provide the only way to meet a patient’s nutritional requirements, where patients have an inaccessible or non-functioning gastro-intestinal system. • PN can be administered via a peripheral or central line. • More information on PN can be found on the BSNA website: link here. 1
Executive Summary • British Specialist Nutrition Association (BSNA) conducted an online survey on PN among 204 HCPs (HCPs), including dietitians, pharmacists, nurses, gastroenterologists, oncologists and intensive care specialists. • The survey highlighted four important factors for improving the use of PN: perception, confidence to manage, the ability to prescribe and training for HCPs. • Moving forward the BSNA welcomes further developments into these areas to improve the role of PN in care settings. 2
Objective and methodology Objective: To gain an insight into HCPs’ views on PN • Online survey with 204 HCPs in the UK. • Robust sample including dietitians, pharmacists, gastroenterologists, nurses, intensive care specialists and oncologists. • The questionnaire was made up of 20 quantitative questions and 11 qualitative questions. • Questionnaires were distributed through professional associations and HCPs’ magazines. 3
The majority of participants were dietitians working in either a district general or teaching hospital Participant demographics by profession and work place • Percentage 204 HCPs answered the survey, their Profession Count Work Location Count Percentage (%) (%) professions were as follows: Dietitian 128 62.7 Teaching Hospital 96 47 • Dietitians (62.7%) • Pharmacists (24.5%) Pharmacist 50 24.5 District General • Nurses (6.4%) 93 46 Hospital Nurse 13 6.4 • Gastroenterologists (4.9%) • Intensive Care Specialists (1%) Gastroenterologist 10 4.9 Other 9 4 • Oncologists (0.5%) Intensive Care Specialist 2 1.0 • And their work locations included: Community 6 3 Oncologist 1 0.5 • Teaching Hospital (47%) Total 204 100 • District General Hospital (46%) Total 204 100 • Community (3%) Other, work locations included: Children's Hospital, • Other (4%) Community/Acute based in teaching hospital, all of the above, retired, academic institution, home and healthcare, GP and hospital. 4
HCPs typically manage 2-5 patients per week with PN The number of patients receiving PN seen by HCPs per week 40 36% • The majority of HCPs (60%) saw <5 patients 35 receiving PN per week. 30 Percentage of HCPs (%) • 18% saw 5 to 10 patients receiving PN per 24% week and 10% saw over 15 patients receiving 25 PN a week. 18% 20 • Of the HCPs managing patients receiving PN, 31% were managing patients on PN in the 15 home setting. 10% 9% 10 5 2% 0 0 to 2 2 to 5 5 to 10 10 to15 15 plus other 5
The majority of patients receive PN for gastroenterological reasons Types of patient receiving PN Surgical interventions with GI complications - 82% e.g. oncology, inflammatory bowel disease • The majority of HCPs were managing patients receiving PN due to either surgical interventions with gastrointestinal complications (82%) or Gastroenterological - e.g. chronic gastroenterological reasons , ie. chronic malabsorption, short bowel syndrome malabsorption, short bowel syndrome, 76% or IBD (76%). inflammatory bowel disease, sclerodoma Non-surgical with GI complications - e.g. • 45% HCPs managed patients receiving PN for non-surgical, GI complications 45% oncology, multiple organ failure and 16% managed patients requiring PN following a vascular accident. • Of the 8% HCPs reporting ‘other’, they managed paediatric patients (eg. Vascular accidents 16% premature neonates, oncology, cardiac), renal patients and intensive care patients receiving PN. Other 8% 0 10 20 30 40 50 60 70 80 90 Percentage (%) *Participants could select more than one option. 6
PN is typically the only source of nutrition given to patients The nutritional support given to patients HCPs were asked: Of the patients they were currently On average HCPs reported that 60% of patients they managed managing with PN, what percentage were receiving: received PN as their only source of nutrition. HCPs reported that 18% of their patients were receiving a PN only combination of PN with oral nutrition. 18% HCPs reported that 16% of the patients they managed received PN in combination with enteral tube a combination of PN with enteral tube feed. feeding HCPs reported that 6% of the patients they managed received 6% PN in combination with enteral tube PN in combination with enteral and oral nutrition. feeding and oral nutritional intake 16% 60% PN in combination with oral nutritional intake (no enteral tube feeding) Pie Chart shows the average percentage of participant’s patients receiving PN, EN and Oral Nutrition 7
The multidisciplinary team is responsible for the decision to prescribe PN The primary decision makers for prescribing PN Respondents also remarked that: • 39% of the responses reported dietitians as a Trust’s primary decision maker for • A consultant was the primary decision maker prescribing PN (73% respondents to this question were dietitians). (13%). • A surgeon (5%), a biochemist (4%) or • Respondents also considered gastroenterologists (23%) pharmacists ( 17%) as primary chemical pathologist (4%) would be decision makers. consulted. Dietitian Gastroenterologist 39% 23% 17% 9% 9% Pharmacist Intensive Care Specialist 1% Nutrition Nurse Specialist Nurse 0 10 20 30 40 50 60 70 80 90 100 * Participants could select more than one option Percentage (%) 8
The majority of HCPs are directly involved with their Trusts’ nutrition support team Level of involvement with Nutrition Support Team by profession I am directly involved as a member of the 37% 2% 4% 56% 12% Nutrition Support Team 77% of respondents reported that their Trust has a in the management of… nutrition support team responsible for PN. Level of involvement I am indirectly involved The majority of participants stated that they were with the Nutrition 7% 5% 2 13% directly involved as a member of the Nutrition Support Support Team when a 0 patient in my care is… Team (56%). I refer patients to the 90% of gastroenterologists are directly involved as a Nutrition Support Team 1 2% 3% member of the Nutrition Support Team for PN. when PN is indicated, Dietitian but have no further… 15% of participants reported that there is no Nutrition There is no Nutrition Pharmacist Support Team and that they are directly involved in the Support Team and I am management of patients receiving PN. 9% 4% 2% 15% directly involved in the Nurse management of… Those that reported ‘other’ stated that that they either cover the dietitian’s role on the support team when Gastroenterologist required or that they didn’t work for a Trust (Scotland). 13% Other (please specify) 7% 2% 1 3% *Percentages are calculated based on the whole sample (204) 9
HCPs believe that PN is a useful tool, when used appropriately HCPs ’ Views on the appropriate use of PN PN can be invaluable for improving nutritional status of 18% patients • The majority (72%) of HCPs viewed PN as useful but that it should be used appropriately. Appropriateness of PN • 18% believe that PN can be invaluable for improving nutritional PN may be useful but should be used appropriately 72% status of patients. • 9% HCPs agreed that PN should not be prescribed unless gastrointestinal function is severely limited. PN should not be prescribed unless gastrointestinal 9% function is severely limited 0 20 40 60 80 Percentage (%) 10
HCPs would consider PN for a patient with a non-functional or inaccessible GI tract Considering PN for a patient when a patient has a non-functional or inaccessible gastro- 97% intestinal tract when a patient is malnourished and has unsafe/inadequate 65% • oral/enteral nutritional intake The majority of HCPs (97%) would consider PN when a patient has a non- functional or inaccessible gastro-intestinal tract. when a patient might not be able to tolerate oral/enteral nutrition in the short to medium term (e.g. peri-operatively, 58% • 65% would consider PN for a patient that is malnourished and has or commencing chemotherapy) unsafe/ inadequate oral/ enteral nutrition intake. when a patient is able to meet some but not all of their needs • 32% HCPs would consider PN for a patient that is nil by mouth and 42% via oral/enteral nutritional intake received no enteral feeding for more than 3 days. when a patient has been nil by mouth and no enteral feeding 32% for more than 3 days 0 20 40 60 80 100 120 Percentage (%) *Participants could select more than one option 11
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