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. 2022 Jul 9;46(8):56.
doi: 10.1007/s10916-022-01835-x.

Offering Guidance and Learning to Prescribers to Initiate Parenteral Nutrition using a Validated Electronic Decision TREE (OLIVE TREE)

Evelyne Van den Broucke #  1   2 , Barbara Deleenheer #  3   4 , Ann Meulemans  5   6 , Julie Vanderstappen  5 , Nelle Pauwels  5   7 , Katrien Cosaert  1 , Isabel Spriet  1   2 , Hans Van Veer  8   9 , Roman Vangoitsenhoven  5   6 , João Sabino  10   11 , Peter Declercq  1   2 , Tim Vanuytsel  10   7   11 , Charlotte Quintens  1   2
Affiliations

Offering Guidance and Learning to Prescribers to Initiate Parenteral Nutrition using a Validated Electronic Decision TREE (OLIVE TREE)

Evelyne Van den Broucke et al. J Med Syst. .

Abstract

Parenteral nutrition (PN) is recommended in patients nutritionally at risk and unable to receive oral or enteral nutrition. A standardized electronic PN order format could enhance appropriate PN prescribing. We developed the OLIVE TREE (Offering guidance and Learning to prescribers to Initiate PN using a Validated Electronic decision TREE), embedded in our electronic health record. We aimed to evaluate its validity and impact on physicians' prescribing behavior. A non-randomized before-after study was carried out in a tertiary care center. The OLIVE TREE comprises 120 individual items. A process validation was performed to determine interrater agreement between a pharmacist and the treating physician. To estimate the proportion of patients for whom the OLIVE TREE had an effective and potential impact on physicians' prescribing behavior, a proof of concept study was conducted. The proportion of patients for whom PN was averted and the proportion of decisions not in line with the recommendation were also calculated. The process validation in 20 patients resulted in an interrater agreement of 95.0%. The proof of concept in 73 patients resulted in an effective and potential impact on prescribing behavior in 50.7% and 79.5% of these patients, respectively. Initiation of PN was not averted and recommendations of the OLIVE TREE were overruled in 42.5% of the patients. Our newly developed OLIVE TREE has a good process validity. A substantial impact on prescribing behavior was observed, although initiation of PN was not avoided. In the next phase, the decision tree will be implemented hospital-wide.

Keywords: Decision tree; Parenteral nutrition; Parenteral nutrition stewardship; Prescribing; Validation.

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References

    1. Khalatbari-Soltani S, Marques-Vidal P. The economic cost of hospital malnutrition in Europe; a narrative review. Clin Nutr ESPEN. 2015;10(3):e89-e94. https://doi.org/10.1016/j.clnesp.2015.04.003 . - DOI - PubMed
    1. Felder S, Lechtenboehmer C, Bally M, Fehr R, Deiss M, Faessler L, et al. Association of nutritional risk and adverse medical outcomes across different medical inpatient populations. Nutrition. 2015;31(11-12):1385-93. https://doi.org/10.1016/j.nut.2015.06.007 . - DOI - PubMed
    1. Barker LA, Gout BS, Crowe TC. Hospital malnutrition: prevalence, identification and impact on patients and the healthcare system. Int J Environ Res Public Health. 2011;8(2):514-27. https://doi.org/10.3390/ijerph8020514 . - DOI - PubMed - PMC
    1. Meulemans A, Matthys C, Vangoitsenhoven R, Sabino J, Van Der Schueren B, Maertens P, et al. A multicenter propensity score matched analysis in 73,843 patients of an association of nutritional risk with mortality, length of stay and readmission rates. Am J Clin Nutr. 2021;114(3):1123-30. https://doi.org/10.1093/ajcn/nqab135 . - DOI - PubMed
    1. Cederholm T, Barazzoni R, Austin P, Ballmer P, Biolo G, Bischoff SC, et al. ESPEN guidelines on definitions and terminology of clinical nutrition. Clin Nutr. 2017;36(1):49-64. https://doi.org/10.1016/j.clnu.2016.09.004 . - DOI - PubMed

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