Journal Club

Managing Nutrition Support in the Home

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Instructions

    Take Another Course

    Post-Test

Resources

Objectives:

Upon completion of this course, the participant will be able to:

1) Identify the effects of long-term and life-long home parenteral nutrition (HPN) on quality of life and health status
2) Identify body composition changes that occur in malnourished patients during the first three months of HPN therapy
3) Describe outcomes in patients with radiation enteritis-induced HPN dependency
4) List strategies in communication to assure a cost effective transition from hospital to home for nutrition support patients.

Introduction:

Home nutrition support is a cost-effective and life saving therapy for patients with intestinal failure. This Journal Club explores recent clinical research that looks at the effects of long-term home nutrition support on quality of life and health status, and the initial changes seen when home parenteral nutrition is initiated in malnourished  patients.

Since the first investigations on intravenous nutrition support as a lifesaving therapy, parenteral nutrition has transitioned into the therapy of choice for those patients requiring feeding but needing to bypass their gastrointestinal tract. Appropriate transition from hospital-based therapy to home-based therapy or for the initiation of parenteral nutrition support in the home requires skilled nursing care, intravenous pharmacy services, and a team approach to education and therapy decision-making. A multitude of skills are required to effectively and efficiently manage home parenteral nutrition.¹ In addition to the importance of clinician education, patients should be well trained to handle their own therapies in the home setting.^2,3

There are a number of patients with disease or surgery that prevents them from adequately absorbing nutrients to sustain health, further impairing their quality of life and threatening their lives who will require short or long-term parenteral support. The home setting is considered a more cost-effective way to provide nutrition support therapy in patients who can otherwise be discharged from an inpatient setting or remain in outpatient care.⁴  Standards of practice issued by the American Society for Parenteral and Enteral Nutrition (ASPEN) for home nutrition support¹ suggest a pathway for optimal management of the homecare patient. These standards include provisions for nutritional screening and assessment, appropriate criteria for home nutrition support candidate selection, establishing and adjusting therapy goals and appropriate formula and equipment prescription, skilled healthcare professional activity according to clear protocols, patient monitoring in implementation and education, and criteria for the termination of therapy. A team approach, with a skilled nurse specialist and patients and caregivers who are well trained, can reduce both the clinical and psychosocial complications of home parenteral nutrition support as well as improve quality of life and cost-effectiveness.^2,3