A comparison of a home parenteral nutrition service with the current European (ESPEN) guidelines on chronic intestinal failure in adults.

Background & Aims: Comprehensive evidenced based guidelines on appropriate and safe provision of home parenteral nutrition (HPN) have been developed by the European Society for Clinical Nutrition and Metabolism (ESPEN) in 2016 and 2020. These guidelines provide clinical standards of care against which the current practice of HPN services can be audited. The aim of this study was to audit a single center's current practice against 183 recommendations on supporting patients on HPN. The objective was to measure compliance and identify areas for quality improvement.

Methods: A retrospective audit of the HPN service received by patients from January 2019-May 2021 was conducted. The ESPEN guidelines were used as a benchmark to measure compliance of healthcare practice. Compliance was evaluated for the 13 subject areas included in the 2016 guideline and the 6 subject areas included in the 2020 guideline. Compliance was calculated as the percentage of criteria fully met for each subject area and an overall compliance rate with each guideline.

Results: Overall, compliance with the recommendations from 2016 was 80% and compliance with the recommendations from 2020 was 65%. Within the 2020 guideline there were 24 recommendations where noncompliance was found, 15 of these were due to the absence of a nutrition support team and dedicated intestinal failure unit.

Conclusion: This audit and evaluation of current practice has identified areas of good evidence-based healthcare practice providing HPN. However, the absence of funding of a nutrition support team to provide a service to patients on HPN was identified as a major barrier to compliance with ESPEN recommendations in this study.