Parenteral nutrition: hospital to home

Stability issues in home parenteral nutrition

Home parenteral nutrition (HPN) is a method of providing nutrients, fluid and electrolytes intravenously to patients with a malfunctioning gastrointestinal tract, at home. Parenteral nutrition (PN) formulations are checked carefully for stability by the hospital pharmacist before the bags are made. However, there are many differences between supplying PN regimens to in-patients on the ward and to patients at home. Transportation between the hospital and home may be prolonged if the patient lives a long way from the hospital and may not be straight-forward. A number of factors can adversely affect the stability of the PN, which in turn can cause complications such as line blockage; or even life-threatening events, such as pulmonary embolism. The hospital team caring for HPN patients needs to be aware of these stability issues if complications resulting from incompatibilities of the solutions in the bags or the infusion line are to be avoided.

Dietitians in home care: a survey of current practice

OBJECTIVE

To determine current practice patterns of dietitians who work in home health care.

DESIGN

A mail survey was sent and a reminder postcard was mailed 2 weeks later.

SUBJECTS

Registered dietitians (1,305) who returned a postcard indicating employment in home care. A total of 660 questionnaires (50.6%) were returned; of these, 252 were usable for data analysis.

STATISTICAL ANALYSES PERFORMED

Descriptive statistics for summary data and a paired t test to compare level of importance and level of expertise needed for nutrition care skills.

RESULTS

The typical respondent was a consultant, relatively new to home care, working fewer than 10 hours a week, and paid an hourly wage (mean=$61.45/hour). Most agencies did not bill separately for nutrition services but 28.2% received third-party payment for services. Primary diagnoses of home care patients were diabetes and cancer. Many dietitians worked with patients receiving enteral tube feedings (55%), total parenteral nutrition (29%), or both (17%), but most made fewer than two visits per week to these patients. Areas of skill rated highest in level of importance for dietitians working in home care were patient counseling, caregiver education, documentation, and dietary history. These plus the ability to develop a care plan received highest expertise ratings. Disparity between skill importance and personal expertise was greatest for activities in the clinical and administrative categories. Most respondents expected growth and role expansion for dietitians in home care, but lack of reimbursement was the greatest deterrent.

APPLICATIONS

To expand their role in the home care field, dietitians need to develop additional skills, improve outcome documentation, diversify roles, and create new relationships with home care providers and case managers.