Impact of total parenteral nutrition standardization led by pharmacist on quality in postoperative patients with colorectal cancer

Abstract

Background/objectives

Abdominal surgery significantly affects the structure and function of the gastrointestinal system of patients, total parenteral nutrition (TPN) is an important nutrition support method for postoperative patients. However, in the process of TPN practice, the excessive fat emulsion and compound amino-acid prescriptions ratio are often prescribed by doctors. To address the problem, we developed the computerized TPN prescription management system to promote the personalized provision of TPN. The purpose of this study is to evaluate the intervention effects of the computerized TPN prescription management system, which is designed by pharmacists in the Surgical Department of Abdominal Oncology at Zhejiang Cancer Hospital in July 2015.

Subjects/methods

The computerized TPN prescription management system applied in Surgical Department of Abdominal Oncology on 1 July 2015. The computerized TPN prescription management system was evaluated by comparing the patients who were treated 3 months after the application of the system with the control subjects who were treated 3 months prior to the application of TPN prescription management system in Surgical Department of Abdominal Oncology.

Results

In total, 218 TPN prescription-treated patients with colorectal cancer received surgery treatment were analyzed, including 121 subjects who received the treatment 3 months prior to application of TPN prescription system (IPN period) and 97 subjects who received the treatment after 3 months of the system application (SPN period). The rates of optimized TPN prescriptions are 47.1% and 88.7% prior to and after application of TPN prescription review system, respectively ( p < 0.001). In detail, prior to application of TPN prescription review system, abnormal glucose–lipid ratio and nitrogen–calorie ratio are the most common problems, which accounted for 74.3 and 97.9%, respectively ( p < 0.01). Whereas the proportion of the insufficient dosage of amino acids is 62 and 96.9%, respectively ( p < 0.01). Other problems are insufficient dosage of insulin and excessive fat soluble vitamin supplement. After application of TPN prescription review system, as the glucose–lipid ratio and nitrogen–calorie ratio are set up in fixed range according to the nutrition treatment guidelines, only a small amount of TPN prescriptions have the problem of insufficient dosage of compound amino acid. Furthermore, before and after the application of TPN management software, the gender, age, performance status (PS) score and BMI index of the two groups of colorectal cancer patients were not statistically different ( p > 0.05). There were significant differences in albumin and prealbumin between the two groups after operation ( p < 0.05), and there was a significant difference in total protein ( p < 0.001). There were significant differences in alanine aminotransferase and indirect bilirubin between liver and kidney function ( p < 0.01), and there were significant differences in aspartate aminotransferase and total bilirubin ( p < 0.05). Other total cholesterol, l-γ-glutamyl transferase, direct bilirubin and creatinine were not statistically different ( p > 0.05). Blood routine (WBC, Hb and lymphocyte), length of stay and recurrence rate were not statistically different ( p > 0.05).

Conclusions

The application of TPN management software not only standardized the doctor’s TPN medical advice, but also improved the qualified rate of TPN doctor’s advice, thus ensuring the safety of the patient’s medication. It also had a positive effect on postoperative recovery of colorectal cancer patients, and ensured the efficacy of the treatment of patients. In addition, it reduced the workload of the pharmacist’s audit prescription and improved the efficiency of the audit prescription, and further emphasized the role and value of pharmacists.