Organizational issues of home parenteral nutrition during COVID-19 pandemic: Results from multicenter, nationwide study

Abstract

Objectives Patients on home parenteral nutrition (HPN) are prone to severe complications of SARS-COV-2 infection. The pandemic requires adaptation of the health care standards, including epidemiological surveillance, logistics of home supply and monitoring. Potential lack of medical professionals may worsen the standard of care. The aim of the analysis was to evaluate the medical staff resources in HPN units. Results The study was conducted by major Polish scientific societies in clinical nutrition. A questionnaire was distributed among all Polish adult HPN centers concerning statistics from the first three months of the pandemic (March-May 2020). Data on medical staff resources and organizational issues of the units were collected. Modifications of the home procedures, SARS-CoV-2 infection rates of HPN patients and health care workers (HCW) were analyzed. Influence of the pandemic on the rates of new qualifications for HAN (home artificial nutrition) was estimated. 14 of 17 adult Polish HPN units took part in the study. The point prevalence of HPN in Poland was 30.75 per million citizens. 344 HCW are involved in patients’ care in Polish HPN units; 18.9% are physicians (49%-surgeons, 18.46%-internal medicine specialists, 15.38%-Anesthesiologists, 7.69%-Pediatricians, 1.54%- Palliative care specialists), 32.27% nurses, 5.23% dietitians, 9.01% pharmacists, 4.94% pharmacy technicians, 3.2% pharmacy assistants, 5.81% administrative workers, 3.49% physiotherapists. HAN Patient to HCW ratios for physicians, nurses, pharmacists, dietitians were respectively: 49.5; 29.15; 111.6; 181.6. Medium age of physicians and nurses was: 45.6 and 44.15. 53.8% of physicians and 31.53% of nurses work parallelly in hospital wards. 31 Pharmacists overall are working in all HPN units (2.21 per unit) and 18 dietitians (1.3 per unit). 9 patients had a confirmed COVID-19 infection (4- HPN, 5-HEN). All the units introduced telemedical solutions in the first months of the pandemic. The number of new qualifications for HPN and HEN in the units did not significantly decline in March-May in comparison with a similar period in 2019. Conclusions A shortage of HPN medical professionals requires attention when planning health care organization, especially during a pandemic. Severe restrictions in public health system may not reduce the number of new qualifications for the HPN procedure. There is a need for the continuation of data collection during the evolution of the pandemic as it may have a detrimental impact on HPN including serious issues with access to professional HCW.

Impact of a multidisciplinary nutritional support team on quality improvement for patients receiving home parenteral nutrition

“…21 Implementation of HPN standards [22][23][24][25] may rely on the treating physicians. [26][27][28] This is concerning because the majority of HPN patients are managed by physicians without nutrition certification (internal data, Amerita].…”