During the COVID-19 pandemic patients with intestinal failure requiring home parenteral nutrition (HPN) or intravenous fluids (IVF) were instructed to shield at home and avoid contact with others. However, maintenance of the delivery of their nutrition or fluids was essential. Could the delivery frequency of their treatment be optimised in order to keep their contact with others to a minimum?
A cohort of 155 patients receiving HPN or IVF from a nutrition support team in a teaching hospital in the north of England were included. A spreadsheet was created to collate the variables which determine the optimum delivery frequency for each patient. These variables were:
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Prescription compounded or non-compounded
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Refrigerator size
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Volume of HPN/IVF
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Number of infusion days per week
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Shortest bag stability on the prescription in days
This information was collected from patients’ prescriptions and homecare provider communication. For compounded HPN the fridge capacity information supplied by a homecare provider and the volume of HPN/IVF were used to ascertain the maximum number of HPN/IVF bags the patient’s refrigerator could accommodate. This was divided by the number of feeding days per week and multiplied by 7. The optimal delivery frequency for an individual patient was the smaller of either the number calculated, or the stability of the shortest expiry bag. The homecare providers delivered weekly, fortnightly or every 4 weeks. If the optimum delivery frequency was <14 days, then a weekly delivery was required. If delivery frequency was 14<28 days then they could have a fortnightly delivery. If delivery frequency was >28 days then a 4 weekly delivery was possible. For non-compounded prescriptions optimum delivery frequency was set at every 4 weeks. The patients’ current delivery frequency, supplied by the homecare provider, was added to the spreadsheet. Where there was a discrepancy between their established delivery frequency and their optimised delivery frequency the patient was contacted by telephone and offered the opportunity to reduce their delivery frequency. For patients who accepted the offer a standard annotation was added to their electronic medical records and their homecare provider advised to make the change.
6 patients were excluded as their prescription changed during data collection and 1 patient required an increased delivery frequency. Of the remaining cohort 34% (n=50) patients were identified as having a delivery frequency that could be optimised. Of those 50 patients, 40% (n=20) were on compounded prescriptions and 60% (n=30) were on non-compounded prescriptions. Of the 50 patients contacted 86% (n=43) agreed to the change. Of the 7 patients who declined the optimised delivery frequency 5 received non-compounded prescriptions. A total of 845 deliveries per year were avoided.
This study demonstrates that there is scope to optimise the delivery frequency of patients receiving HPN or IVF and that it is largely acceptable to patients. We have demonstrated a successful system for identifying patients where there is opportunity to optimise. Most of the patients who declined the optimised delivery schedule declined due to limited storage capacity. This was particularly evident in patients who had non-compounded prescriptions who would be required to store 4 weeks’ worth of HPN and/or IVF. This method provides further protection for patients with intestinal failure who require HPN or IVF by reducing avoidable contact with others.