4CPS-189 Assessing adherence to espen guideline recommendations on paediatrics parenteral nutrition

BackgroundPlenty of studies have demonstrated that physicians’ adherence to guidelines is poor. However, there is a lack of research investigating the relationship between adherence and the strength of recommendations.PurposeTo investigate the relationship between adherence to European Society for Clinical Nutrition and Metabolism (ESPEN) guidelines on paediatrics parenteral nutrition (PN) and the strength of recommendations (SoR).Material and methodsA 7 month retrospective observational study was conducted of consecutive admitted paediatric patients who underwent PN between 1 November 2016 and 31 May 2017. Inclusion criteria were as follows: patients receiving PN for the first time and for at least 3 days. Data were collected from the Kabisoft® e-prescribing software for clinical nutrition. Adherence to recommendations using explicit prescribing criteria was assessed and the SoR of each one of them was recorded.ResultsOverall, a total of 1619 prescriptions were assessed for adherence to recommendations. The number of patients qualifying for inclusion was 45, their median age was 1 day (range, 0 to 5405) and 57.8% were males. The mean duration of NP therapy was 16.36 days (SD=±9.90). Adherence was higher in the case of recommendations related to the prescribing of macronutrients. Physicians adhered more to recommendations regarding the consumption of amino-acids and minerals, and less to those on energy and vitamins’ intake. When analysing non-adherent prescriptions, higher discrepancies between prescribed and recommended doses were observed in SoR D recommendations compared to SoR C ones. Discrepancies between prescribed and recommended doses in SoR D, micronutrients and vitamins’ recommendations had a median of 33.5%, 58.5% and 60.2%, respectively. Adherence was associated with a higher SoR rating: SoR A and SoR B recommendations were followed in 100% of the cases, whereas SoR C and SoR D ones were followed in only 76.1% and 37.8% of the prescriptions, respectively.ConclusionSince adherence was found to be positively associated with SoR ratings, authors investigating adherence to guidelines’ recommendations should report results per SoR rating. Otherwise, the prevalence of evidence-based prescribing may be biasedly reported in scientific publications.Reference and/or Acknowledgements1. Guidelines on Paediatric Parenteral Nutrition of the ESPGHAN and ESPEN, Supported by the European Society of Paediatric Research (ESPR)2005.No conflict of interest