Background: In line with recent guidance from both ASPEN/ESPEN to cluster care to minimize healthcare team exposure by relying on other providers or telehealth to collect relevant nutrition assessment, our nutrition support team has adopted a modified workflow, leveraging information technology to provide parenteral nutrition (PN) remotely in a safe and timely manner. We aim to compare our prescribing adequacy and PN-related complications before and during COVID-19 outbreak using the modified workflow in non-critically ill patients.
Method: This study reviewed a prospectively recruited cohort of adults (>18 years old) started on PN in the general wards or high dependency units from 5th of December 2019 to 15th of April 2020. Demographic data, nutrition assessment, PN prescriptions, blood results, electronic notes, capillary blood glucose (CBG) monitoring and CRBSI rates were reviewed for patients who received PN.
Result: In our study, we found that patients who started PN during COVID-19 were more malnourished with lower BMI and higher proportion of SGA B/C(52 (92.9%) vs 36 (73.5%) p<0.005) . Proportion of patients who achieved target calories within 5 days were similar in both groups. Protein prescription was >1g/kg/day in both groups, though there was a trend of higher protein prescription during COVID-19. Complications were similar in both groups.
Conclusion: Our study demonstrates that minimal contact with effective multidisciplinary communication using the modified workflow can allow for safe and timely PN administration.
Reference:Salazar E, Yen PB, Ye CL, Boo TL, Wen YP, Chuen MCC. A modified minimal contact COVID-19 workflow allows for safe, remote, parenteral nutrition prescribing in non-critically ill patients. JPEN J Parenter Enteral Nutr. 2021 Mar 10. doi: 10.1002/jpen.2104. Epub ahead of print. PMID: 33694246.