ABSTRACT
BACKGROUND: Monitoring hospitalized patients receiving parenteral nutrition requires regular bloodwork. However, blood specimens, if not drawn appropriately, may be contaminated by parenteral nutrition, leading to spurious results and unnecessary medical interventions. The objective was to determine, in a large academic center, the frequency of spurious bloodwork, unnecessary medical interventions, and contributing factors. METHODS: This was a 1-year prospective cohort study monitoring hospitalized patients receiving parenteral nutrition and their bloodwork. Sudden unexplained changes in serum levels of glucose, potassium, and sodium were identified. Subsequent medical interventions were tracked. Factors affecting blood collection, such as technique, shifts, nursing units, nursing, and patient demography, were assessed and compared with those of a control group. RESULTS: Out of 201 patients, 34 had 63 incidents of spurious bloodwork. This led to 23 medical interventions. The most frequent problem was the failure to clamp the parenteral nutrition infusion prior to blood collection or too short a time between clamping and drawing. There was an increased occurrence of spurious bloodwork drawn by nurses with < 10 years of experience due to failure in following blood collection policy. Cost of spurious bloodwork and subsequent interventions for 63 incidents was approximately $3480 (CAD) per year. This excluded physician time. CONCLUSIONS: Spurious bloodwork was due to parenteral nutrition contamination by incorrect blood draw techniques. This led to a policy amendment to incorporate a "wait time" between stopping the parenteral nutrition infusion and drawing blood and to an institution-wide nursing reeducation.
Subject(s)
Blood Specimen Collection/methods , Hospitalization , Medical Errors , Parenteral Nutrition/methods , Blood Glucose/analysis , Clinical Competence , Cohort Studies , Female , Hematologic Tests , Humans , Infusions, Intravenous/methods , Male , Middle Aged , Prospective StudiesABSTRACT
BACKGROUND: Telehealth videoconferencing is a medium for health care professionals to communicate and care for patients living in remote areas. The aim of this study was to provide a survey to examine management outcome of home parenteral nutrition (HPN) patients when followed by telehealth as an alternative modality of care. METHODS: Twenty-six individuals who were identified to benefit from tele-health were invited to participate in a satisfaction survey. The survey was sent to patients by postal mail. The survey also documented the incidence of line sepsis and other medical HPN complications. A cost analysis was also performed according to technology, human resources, and infrastructure. RESULTS: Eighty-one telehealth videoconference sessions have been held since the inception of telehealth in 2002. Of the current telehealth patients, 13 were eligible for the survey. The satisfaction survey response rate was 11/13 (84.6%). The average line sepsis rate for the 13 patients was 0.89/1000 catheter-days. All patients were generally satisfied with videoconferencing as an alternative method of communication and care for new consultation, patient and family education, and follow-up. Travel time and costs to the patients, their families, and the health care system were significantly less. For example, a patient who resides 611 km from Toronto would cost CDN (Canadian) 724.00 dollars for flight and accommodation to meet with the team at the HPN clinic in Toronto. CONCLUSION: Telehealth incorporated the cost-saving ability for HPN patients to maintain proper medical care, support, and collaboration of specialists inaccessible to their local community. Thus, its strongly positive role in HPN care deserves further consideration for a national application.
Subject(s)
Continuity of Patient Care/standards , Parenteral Nutrition, Home/standards , Remote Consultation/methods , Sepsis/epidemiology , Adult , Aged , Catheters, Indwelling/adverse effects , Cost-Benefit Analysis , Female , Health Care Surveys , Humans , Male , Middle Aged , Ontario , Parenteral Nutrition, Home/adverse effects , Patient Satisfaction , Retrospective Studies , Time FactorsABSTRACT
BACKGROUND: High urinary oxalate levels have been associated with high ascorbic acid intakes. An alteration in the vitamin regimen for home parenteral nutrition (HPN) patients because of product discontinuation resulted in provision of 500 mg instead of 100 mg ascorbic acid per HPN day. This regimen was associated with high urinary oxalate levels. PURPOSE: To determine if a switch from a multivitamin regimen containing 500 mg to one containing 100 mg of ascorbic acid daily would reduce urinary oxalate levels. METHODS: A 24-hour urine collection for oxalate was analyzed before switching the vitamin regimen back to 100 mg ascorbic acid and repeated 2 months after the change. A paired t test was conducted to compare measurements at baseline and at 2 months. RESULTS: Overall, 18 patients completed both phases of this observational study. The initial urinary oxalate of 517 +/- 63 micromol/day decreased to 425 +/- 47 micromol/day after 2 months (p = .05). However, after applying the exclusion criteria, only 6 patients could be included. The baseline urinary oxalate of 649 +/- 106 micromol/day decreased to 391 +/- 57 micromol/day after 2 months (p = .006). CONCLUSIONS: A change in the parenteral regimen of HPN patients from 500 mg ascorbic acid to 100 mg ascorbic acid is associated with a decrease in urinary oxalate levels. This suggests that a moderate dose of parenteral ascorbic acid (100 mg/day) may limit urinary oxalate appearance in HPN patients.
