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99 ‘To feed or not to feed’: review of practice in an acute hospital trust around initiation and withdrawal of parenteral nutrition (PN) in palliative patients
  1. David J Matthews and
  2. Farida Malik
  1. East Sussex Healthcare NHS Trust


Background/Introduction National and European guidance around use of PN in palliative patients emphasises the need to consider risks, benefits, and impact on QOL with it unlikely to be appropriate in the last weeks of life. Starting PN can delay discharge from hospital to other settings and affect PPC/PPD.

Aims/Objectives To assess whether local processes around initiating and withdrawing PN for hospital inpatients with palliative care needs are in line with current guidance.

Methods Retrospective case review: All Patients prescribed PN feed over a 6-month period identified by pharmacy and known to the hospital supportive and palliative care team (SPCT) were recruited and their notes reviewed regarding indication for PN, evidence of discussions around initiation and withdrawal, date PN started and stopped, interventions planned/performed, details of SPCT involvement, and patient outcomes. Data analysed using descriptive statistics.

Results 183 patients received PN over 6-month period. 33 were known to SPCT. SPCT involvement began after PN initiation for 77% of patients. Wide range of indications for initiation, most common being oesophageal obstruction (16%). Most commonly withdrawn because patient approaching terminal phase (52%.) Relevant documented discussions with patients/families recorded in 29% prior to initiating PN (none involved SPCT) and 26% prior to withdrawing PN (half involving SPCT). Nearly half (48%) of patients died within 2 weeks of starting PN (65% within 4 weeks). Importantly 26% died within 24 hrs of stopping PN. Over 2/3 died in hospital. 65% had no intervention planned to stop the need for ongoing PN at the time of initiation. Findings showed results were not in line with current national guidance

Conclusion/Discussion Decision for SPCT to be involved in all MDT discussions prior to PN initiation in palliative patients incorporated into new hospital guidelines. Introduction of proforma planned to record initiation discussions in medical notes. Outcomes following changes will be reaudited.

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