Page 24 - Q BULLETIN, Ministry of Health Malaysia, VOLUME 1, NO. 31 (SUPPLEMENT 1), JAN-DEC 2022

Q Bulletin, Volume 1, No. 31 (Supplement 1), Jan - Dec 2022
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11 National QA Convention, 4 – 6 October 2022
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Improved Care through Better Nutrition: Value and Effects of Medical Nutrition

Gill JK , Krishnasamy K , Wong WJ , Poh KL 4
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3
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1 Pharmacy Department, University Malaya Medical Centre (UMMC), Kuala Lumpur
2 Nursing Department, University Malaya Medical Centre (UMMC), Kuala Lumpur
3 Surgical Department, University Malaya Medical Centre (UMMC), Kuala Lumpur
4 Dietetic Department, University Malaya Medical Centre (UMMC), Kuala Lumpur

SELECTION OF OPPORTUNITIES FOR IMPROVEMENT:
The absence of a multidisciplinary nutrition support team (NST) in addressing malnutrition issues and
optimal nutritional care to severely ill patients for nutrition assessment, determination, recommendations and
monitoring of nutrition therapy led to an improper prescribing pathway for Parenteral Nutrition (PN).

KEY MEASURES FOR IMPROVEMENT:
The indicator of this study is the percentage of prescribing and administration errors of Parenteral Nutrition in
surgical wards and Intensive Care Unit (ICU), with the standard set as 0%.

PROCESS OF GATHERING INFORMATION:
Retrospective pre-interventional data were collected using patient charts for indication of PN, duration of
therapy, blood parameters, and demographic data and incurred costs based on PN supply in surgical wards and
ICU.

ANALYSIS AND INTERPRETATION:
During the pre-intervention phase, 80% of the prescribing errors and 58% of the administration errors of
Parenteral Nutrition were reported. The contributing factors identified were the absence of a dedicated team in
managing PN therapy, untrained personnel, and inadequate nutrition assessment.

STRATEGIES FOR CHANGE:
A multidisciplinary nutritional support team was assembled to have weekly ward rounds on patients receiving
Total Parenteral Nutrition (TPN) and enteral nutrition in the surgical wards and critical care units with nutritional
support education and plans, referencing the European Society of Parenteral and Enteral Nutrition (ESPEN)
guidelines. Interventions made by the team were logged and reviewed during nutritional support subcommittee
meetings for physician oversight.

EFFECT OF CHANGE:
During the post-intervention, the percentage of prescribing errors of Parenteral Nutrition was reduced to 35%,
and percentage of administration errors reduced to 10%. The achievable benefit not achieved (ABNA) gap has
been reduced by 45% for prescribing errors and 48% for administration errors.

THE NEXT STEP:
These strategies will be continued to ensure the sustainability of the improvement done. We plan to expand
these strategies to other clinical areas. We are also in the process of collaborating with other government
hospitals to provide Home PN services for patients at home.

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