Monitoring of patients on home parenteral nutrition (HPN) in Europe: A questionnaire based study on monitoring practice in 42 centres

Introduction & aim To gather information about how adult patients on home parenteral nutrition (HPN) are monitored after discharge from the hospital. Method A questionnaire about HPN monitoring practice was circulated to HPN centres in eight European countries through the representative of the ESPEN1 HAN-working group2. Centres were asked about guidelines, home visits and how monitoring and handling of complications were managed. Results Fourty-two centres in eight European countries completed the questionnaire: UK n=14, France n=9, Belgium n=4, Italy n=4, Poland n=4, Denmark n=4, Spain n=2, Germany n=1. The HPN experience of the centres was in the range 2–30 years. Centres ranged in size from 0 to 125 HPN patients representing a total number of 934 of whom 54% had received HPN for more than 2 years. The primary disease was non-malignant in 90% whilst 10% had been diagnosed with active cancer. Of the centres 92% had a HPN team and 66% had written guidelines for monitoring HPN. Home visits after discharge for monitoring purposes were carried out by 31 of the centres involving the HPN team, general practitioner, community nurse or home care agency. Stable patients on HPN for more than 12 months were monitored at the discharging hospital (73%), at a local hospital (12%), by the General Practitioner (11%) or by a home care agency (4%). Of the centres, 90% reported that the main responsibility for monitoring was assigned to a specific person. The intervals between monitoring visits for the stable HPN patient was in the range 1–6 months, 52% of the centres reported intervals of 2–3 months. In case of complications 76% of centres reported that patients got in touch with the HPN team, 2% the local hospital, 5% the home care agency, and 17% other. Re-admission to hospital was usually to the HPN centre and only occasionally to a local hospital. Conclusion In Europe a specialised team at the discharging hospital monitors HPN patients and 66% of the centres had some kind of written guidelines.