Nutritional support of the hospitalized patient. The team concept
Nehme, A.E.
JAMA 243(19): 1906-1908
1980
ISSN/ISBN: 0098-7484 PMID: 6767864 Document Number: 163853
The team approach to management of 211 patients on total parenteral nutrition (TPN) was compared to that of 164 patients on TPN being supervised by their physicians over a period of 2 years. The team consisted of a physician, a pharmacist, a nurse, clinical dietitians and an infection control coordinator. Team patients received a complete nutritional assessment prior to therapy including anthropometric measurements, biochemical analysis and immunocompetence evaluation, and were monitored on a daily basis for needed modifications. The nonteam patients were usually put on TPN on the basis of general condition, ability to eat, and appetite. Comparisons were made for catheter insertion complications, sepsis, and metabolic complications. Team patients had complications associated with catheter insertion at a rate of 3.7%, while 33.5% of nonteam patients did. Sepsis occurred in 1.3% of team patients, and 26.2% of the other group. Metabolic complications, including electrolyte imbalance, high ammonia, rebound hypoglycemia, etc., were far greater in the nonteam group. A well-established protocol for the administration of TPN results in better patient care, with therapeutic as well as economic benefits.