Jamie Haselhorst, RD, CNSC1, Rebecca L. Brown, RD, CNSC2, Casey Cooper, PharmD, CNSC3, Shannon Slate, PharmD, CNSC4, Debbie Stevenson, RD, CNSC2, Diana Ogden, RD5
1Amerita Specialty Infusion Services, San Antonio, TX; 2Amerita Specialty Infusion Services, Centennial, CO; 3Amerita Specialty Infusion Services, Amarillo, TX; 4Amerita Specialty Infusion Services, Nashville, TN; 5Amerita Specialty Infusion, Prescott, AZ
Introduction: Home initiation of parenteral nutrition (PN) has been a successful practice for over 20 years. Some healthcare teams are not comfortable initiating PN in the home setting. The principal concern is related to patient safety and the risk of refeeding syndrome. The primary purpose of this study is to evaluate the safety and efficacy of home start PN. With increasing costs associated with the provision of healthcare, a cost-analysis is an important secondary factor to consider.
Methods: The study was approved by the pharmacy's clinical compliance team. Protected health information was not included, informed consent was not required. A retrospective chart review was conducted on adults > 18 years of age that started on home PN between 6/1/2017 and 6/30/2018. We excluded individuals when therapy was less than 30 days. Data included the occurrence of hospitalizations, ER visits, central venous access device events (CVAD) and Adverse Drug Reactions (ADRs) in the first 30 days of therapy. Incidence of refeeding syndrome was determined for the home initiated PN patients. The number of days it took home start PN patients to reach caloric goal, defined as goal calories outlined in the initial nutrition assessment, was obtained. The sample groups were analyzed using a two-sample t-test (assuming equal variances) with one-tailed P values to demonstrate statistical significance.
Results: 62 home start PN patients met criteria. 62 patients from the same geographical locations who started PN during the same time in the hospital setting were randomly selected as a control group. A statistically significant (P < 0.05) improvement in 30-day hospital readmissions was demonstrated in the home start PN group (P =0.02). Using a 95% confidence interval, statistical non-inferiority was demonstrated in the number of ER visits, CVADs, and ADRs in the home start PN group (Fig 1). The incidence of refeeding syndrome in the home start population was 11.11%, which is comparable to previously published studies. Avg. days to goal for the home start PN patient was 9.7 days. (Table 1)
Discussion: Patients with home initiated PN had fewer hospital admissions after starting therapy than hospital start PN. Home start PN provides a cost savings of approximately $2000 per day (Fig 2). Starting PN in the home setting reduces exposure to hospital acquired infections in patients. Home start PN is a safe alternative and should be considered given the cost savings, fewer readmissions, and preventing hospital-acquired infections.
Citation: Jamie Haselhorst, RD, CNSC; Rebecca L. Brown, RD, CNSC; Casey Cooper, PharmD, CNSC; Shannon Slate, PharmD, CNSC; Debbie Stevenson, RD, CNSC; Diana Ogden, RD. P1761 - HOME INITIATED PARENTERAL NUTRITION IS A SAFE AND COST-EFFECTIVE APPROACH TO NUTRITION SUPPORT. Program No. P1761. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.