[Improving the accuracy of caregiver-provided in-home total parenteral nutrition care].

Background & Problems: According to current surveys conducted between September and December 2011, the accuracy of primary caregiver-administered Home Total Parenteral Nutrition Care (HTPNC) was 62.0%. Further, nursing staffs provide instruction on HTPNC to only 22.2% of caregivers responsible for administering HTPNC. Main related causes were: (1) difficult to comprehend health education tools; (2) inconsistent nursing guidelines; (3) a lack of relevant standard operating procedures; and (4) poor caregiver adoption of TPN skills.

Purpose: This project was developed to (1) increase the accuracy of primary caregiver-administered HTPNC to 90% and (2) increase the percentage of nurse-administered HTPNC to 90%.

Resolutions: We developed appropriate nursing guidelines, created a health education CD-ROM with input from a cross-disciplinary team and total parenteral nutrition focus group, designed reusable teaching model aids for repetitive practice, and held regular group health education sessions.

Results: The nursing staff HTPNC instruction rate increased to 100%. Caregiver HTPNC implementation accuracy increased to 100% prior to patient discharge.

Conclusions: This approach was successful in achieving its stated goals. Further, using reusable teaching model aids may reduce caregiver anxiety and increase caregiver confidence. The greatest benefit of this project was its extension of teaching model aids to relevant units, allowing for routine monitoring by the department of nursing quality management.