JPEN J Parenter Enteral Nutr. 2021 Aug 5. doi: 10.1002/jpen.2247. Online ahead of print.
ABSTRACT
BACKGROUND: Overprescribing of PN increases costs and risks to patients, including from central line-associated blood stream infection (CLABSI). With CLABSI reduction in mind, our children’s hospital began an iterative QI effort to decrease PN utilization by first ensuring appropriate initiation and then defining and ensuring appropriate discontinuation.
MATERIALS AND METHODS: An educational campaign was launched along with audits to evaluate for appropriate PN indications. Next, a literature review was conducted to guide the development of an algorithm to appropriately wean and discontinue PN in pediatric patients. Lastly, all PN discontinuations were audited for agreement with the new guideline. Retrospectively, monthly PN utilization index (orders/patient-days) was plotted on a statistical process control chart to assess change over time. The presence of PN as a risk factor for CLABSI events and the overall hospital CLABSI rate were trended.
RESULTS: Mean PN utilization index fell from 0.156 (July 2018-January 2019) to 0.12 (February 2019-August 2020) (p < 0.01). For 18 months, no PN utilization index reached the baseline lower control limit of 0.144, demonstrating special cause variation and a sustained change. PN as a risk factor for hospital CLABSI cases decreased from most prevalent (49% of cases) to fifth most prevalent (29%), as the CLABSI rate trended down.
CONCLUSION: Engaging frontline staff in the development of a clinical practice guideline and increased accountability to reduce potential patient harm led to a significant and sustained reduction in PN utilization, as well as decreased prevalence of PN as a risk factor in hospital CLABSI cases. This article is protected by copyright. All rights reserved.
PMID:34350991 | DOI:10.1002/jpen.2247
