key: cord-0859945-0lcl8m5k authors: Salazar, Ennaliza; Poh, Bee Yen; Cheang, Lai Ye; Tan, Lee Boo; Yong, Pay Wen; Cheah, Mark Chang Chuen title: Modified minimal‐contact COVID‐19 workflow allows for safe, remote parenteral nutrition prescribing in non–critically ill patients date: 2021-04-20 journal: JPEN J Parenter Enteral Nutr DOI: 10.1002/jpen.2104 sha: f7ac043f96e90fdc6268d1407995bc16200d3d1e doc_id: 859945 cord_uid: 0lcl8m5k BACKGROUND: In line with recent guidance from the American Society for Parenteral and Enteral Nutrition (ASPEN) and the European Society for Clinical Nutrition and Metabolism (ESPEN) to minimize healthcare team exposure by clustering care and relying on other providers or telehealth to collect relevant nutrition assessments, our nutrition support team has adopted a modified workflow using information technology to provide parenteral nutrition (PN) remotely in a safe and timely manner. We aim to compare our prescribing adequacy and PN‐related complications before and during the coronavirus disease 2019 (COVID‐19) outbreak using the modified workflow in non–critically ill patients. METHODS: This study reviewed a prospectively recruited cohort of adults receiving PN in the general wards or high‐dependency units from December 5, 2019, to April 15, 2020. Demographic data, nutrition assessment, PN prescriptions, blood results, electronic notes, capillary blood glucose monitoring, and catheter‐related bloodstream infection rates were reviewed for patients who received PN. RESULTS: We found that patients who started PN during COVID‐19 were more malnourished with lower body mass index and higher proportion of Subjective Global Assessment B/C scores (52 [92.9%] vs 36 [73.5%], P < .005). The proportion of patients who achieved target energy amounts within 5 days was similar in both groups. Protein prescription was >1 g/kg/day in both groups, though there was a trend of higher protein prescription during COVID‐19. Complications were similar in both groups. CONCLUSION: Our study demonstrates that minimal contact with effective multidisciplinary communication using the modified workflow can allow for safe and timely PN administration. The global coronavirus disease 2019 (COVID-19) pandemic has had a lasting impact on healthcare delivery. Healthcare workers worldwide have adopted vigilant precautions with regard to hand hygiene and using personal protective equipment (PPE) while attending to hospitalized patients. 1 Parenteral nutrition (PN) is an integral supportive therapy in managing patients with intestinal failure in the acute hospital setting. 2 In line with recent guidance from both the American Society for Parenteral and Enteral Nutrition (ASPEN) and the European Society for Clinical Nutrition and Metabolism (ESPEN) to minimize healthcare team exposure by clustering care and relying on other providers or telehealth to collect relevant nutrition assessment to prescribe PN, 3, 4 our nutrition support team (NST) has adopted a modified workflow that uses information technology to minimize patient contact while providing PN in a safe and timely manner. Daily physical review was replaced by NST pharmacists, dietitians, and physicians meeting in a nonclinical area, practicing social distancing, reviewing patient electronic charts, and prescribing PN remotely. Robust electronic documentation allowed the NST to review patient fluid balance, enteral intake, central-line access, blood investigations, and CBG levels in order to adjust the PN prescription and create electronic notes for nutrition management remotely. Clarifications regarding the prescribed nutrition therapy were discussed between the NST and the managing team via telephone or secure messaging. Only in cases when a clinical decision was not reached via nonphysical communication would the NST physician assess the patient in person. The Mann-Whitney U test was used for continuous variables. The Fisher exact test was used for categorical variables. SPSS (Version 25.0, IBM Corp, Armonk, NY, USA) was used for statistical processing. A P <.05 was considered statistically significant. Coronavirus disease (COVID 19) pandemic. World Health Organization Management of acute intestinal failure: a position paper from the European Society for Clinical Nutrition and Metabolism (ESPEN) Special Interest Group Nutrition Therapy in the Patient with COVID-19 Disease Requiring ICU Care. American Society for Parenteral and Enteral Medicine and Society of Critical-Care Medicine ESPEN expert statements and practical guidance for nutritional management of individuals with SARS-CoV-2 infection Modified minimal-contact COVID-19 workflow allows for safe, remote parenteral nutrition prescribing in non-critically ill patients We thank Rachel Goh (BPharm), Peh Hui Yee (BSc), and Janet Chong Ngian Choo (BHSN), who contributed to data collection for the inpatient PN registry.> None declared. None declared.