Authors (including presenting author) :
Chan PK (1), Chan CW (2), Kwan WM (3), Li STR (4), Lau YH (5), Chan CY (1), Fong SM (4)
Affiliation :
(1) Department of Surgery; (2) Department of Pharmacy; (3) Department of Dietetic; (4) Department of Medicine & Geriatrics; (5) Department of Intensive Care Unit
Introduction :
Nutrition support is vital in prevention and treatment of malnutrition. However, injudicious use of parenteral nutrition (PN) and inappropriate monitoring can increase risk of developing life-threatening complications. Overseas studies supported the establishment of a multidisciplinary Nutrition Support Team (NST) to oversee the nutritional status and therapy of patients who need nutritional support. NST including surgeon, gastroenterologist, intensivist, dietitian, pharmacist and nurses, has been established to ensure the quality and safety of nutritional treatments in Princess Margaret Hospital (PMH)
Objectives :
NST aims to optimize nutritional support by suggesting appropriate PN formulae and dosage, as well as identifying and rectifying metabolic and nutritional complications related to PN.
Methodology :
Upon referrals by doctors, nurses, dietitians or pharmacists to NST, patients who have complex nutrition problems and requiring PN for nutrition support will be assessed in the NST ward round weekly. Continuous monitoring of laboratory results and pre-emptive interventions on PN prescriptions will also be done by NST members.
Result & Outcome :
Seventeen patients aged 16 – 85 years were involved in the NST consultations between January 2023 and December 2024 at PMH, in which 78 NST reviews and 198 interventions were performed. The common comorbidities of the cases were bowel obstruction (35.3%), malabsorption disorder such as short gut syndrome (29.4%) and enter-cutaneous fistula or ileostomy (17.6%). All patients were on PN therapy with at least one abnormal value of serum electrolytes, triglycerides, micronutrients or liver function test. Laboratory results checking and monitoring for treatment plan modification (66.7%) was found to be the most common intervention by NST, followed by fluid and electrolytes adjustment (17.7%) and supplementation of micronutrients (10.6%). Hypophosphatemia (47%) and Vitamin D deficiency (23.5%) were the most frequent problems identified in electrolyte and micronutrients monitoring. Over 90% of all the blood abnormalities were corrected after following NST interventions.
Multidisciplinary approach of NST service can positively impact the nutrition support and can optimize the safety of PN use in patients with multiple comorbidities.
