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The NCEPOD report on Parenteral Nutrition June 2010

The NCEPOD report on Parenteral Nutrition June 2010. Dr Mike Stroud FRCP Chair British Association for Parenteral & Enteral Nutrition Senior Lecturer in Medicine & Nutrition, IHN Consultant Gastroenterologist, Southampton Chair of NICE GDG on Nutrition Support.

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The NCEPOD report on Parenteral Nutrition June 2010

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  1. The NCEPOD report on Parenteral Nutrition June 2010 Dr Mike Stroud FRCP Chair British Association for Parenteral & Enteral Nutrition Senior Lecturer in Medicine & Nutrition, IHN Consultant Gastroenterologist, Southampton Chair of NICE GDG on Nutrition Support

  2. A multi-disciplinary charity committed to raising awareness of malnutrition and options for its treatment; and examining impacts on health outcomes, resource utilization and health/social care budgets.

  3. Food intake, absorption, losses and demands

  4. Nutritional |Care and Quality - the BAPEN Agenda 2009/10 – a framework for Commissioners and Providers to establish safe quality care standards in nutritional care from food and supplements at one end of the spectrum to the highly specialised PN at the other. Malnutrition Matters Meeting Quality Standards in Nutritional Care Ailsa Brotherton, Nicola Simmonds and Mike Stroud on behalf of the BAPEN Quality Group

  5. BAPEN Toolkit Four key tenets: • Screen to identify nutritional care needs followed by detailed assessment • Care pathways in place with appropriate monitoring • Training for all staff to appropriate levels • Management structures in place to support the delivery of safe nutritional care of the highest quality

  6. 100 95 90 85 80 Catabolic 75 Complete starvation 70 Partial starvation 65 60 55 50 0 10 20 30 40 50 60 70 Starvation & Weight loss (After Allison) % Decision Box b o d y w e i g h t Days

  7. 100 95 90 85 80 Catabolic 75 Complete starvation 70 Partial starvation 65 60 55 50 0 10 20 30 40 50 60 70 A Patient’s Journey GP GP % OP IP b NBM for Ix o Surgery d y w e i g h Not going well - Friday t Days

  8. Nutrition support in adults: 2006

  9. Nutrition support SCREEN RECOGNISE TREAT ORAL ENTERAL PARENTERAL MONITOR REVIEW

  10. Parenteral nutrition if patient malnourished/at risk of malnutrition a non functional, inaccessible or perforated gastrointestinal tract and has either inadequate or unsafe oral or enteral nutritional intake introduce progressively and monitor closely use the most appropriate route of access and mode of delivery stop when the patient is established on adequate oral intake from normal food or enteral tube feeding D

  11. The Evidence Wanted – starving IF volunteers for PN RCTs

  12. Evidence for enteral and parenteral nutrition IBO

  13. The NCEPOD report on Parenteral Nutrition June 2010

  14. BAPEN’s Response • Dismay • Congratulations and welcome • solid evidence that many hospitals deliver unsafe artificial nutrition to vulnerable adults and babies. • Generally irrefutable data confirming what BAPEN NICE and others have said for some time i.e standards in nutritional care must be improved to ensure all patients receive quality, safe and equal treatment from staff who are appropriately trained and supervised

  15. ? NSTs surely BAPEN NSTs

  16. PN needed in Intestinal Failure – Should be level 2 patients ?IFU

  17. Difficulties with definition and methodology But its bad! Refeeding syndrome Catheter related sepsis

  18. PN should only be given when necessary When PN is needed recognise early and take action Patient assessment should be robust and purpose and goal documented Regular documented clinical and biochemical monitoring Additional IV fluids only if necessary Active education about the role of PN, its complications and side effects All hospitals should have a PN proforma Catheter and organizational NCEPOD Recommendations

  19. All acute hospitals must have multi-disciplinary NSTs with Senior Clinical Leadership All acute hospitals should have simple rolling system of PN registration and audit to monitor practice and secure improved standards this could be delivered by extending BAPEN’s existing BANS database covering long-term home PN patients and it would support work by HIFNET - the newly established commissioning, management and clinical framework dealing with intermediate and long-term PN BAPEN’s Recommendation’s This needs political will and DH support

  20. BAPEN's Challenge • We challenge the Coalition Government to implement fully the recommendations from this NCEPOD report and those from the Delivery Board of the Nutrition Action Plan • political leadership for malnutrition and risk • a public and professional awareness campaign on the impact of poor nutritional status on health outcomes

  21. BAPEN Agenda 2019/11Safety in Nutritional Care BAPEN will ensure top-level leadership through an All Party Parliamentary Group on Nutritional Care and Hydration. with parliamentary and professional partners Aim - To ensure that safe nutritional care of all types continues to make its way up political, professional and practical agendas for the benefit of patients and people of all ages across primary, secondary and community settings. Screening Catering Oral Nutrition Supplements ETF Under-hydration and IV fluids PN

  22. Thank you

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