CLINICAL PATHWAYS IN-HOME NUTRITION SUPPORT

In home-care settings, physicians with various medical specialties may order home enteral and/or parenteral nutrition support. Clinical path ways may be used to provide a clear, concise, standardized method for ordering and monitoring home nutrition support. The clinical pathways should be appropriate for 80% of the patients placed on the pathways, allowing for a 20% variance, or deviation, from the pathway. In one ho me-care facility, disease-specific clinical pathways have been used fo r longer than 1 year for patients with a variety of diseases requiring home nutrition support. To determine the usefulness of the home nutri tion support clinical pathways, data obtained from 20 patients were an alyzed. Patients were followed up while being treated using home nutri tion support clinical pathways designed for oncology (9 patients), hum an immunodeficiency virus/acquired immunodeficiency syndrome (2 patien ts), short bowel syndrome (6 patients), and hyperemesis (3 patients) f or 191 weeks. Overall, an average variance (deviation from the pathway ) of 22% (the number of variances divided by the total weeks of therap y) was observed. The use of the pathways to provide enteral or parente ral nutrition facilitated more cost-effective care by following pathwa y guidelines for obtaining laboratory values and patient visits. Commu nication between the home-care staff and the physician was also improv ed. Clinical pathways can enable standardization of care for patients receiving nutrition support at home.