PD248 - REDUCING REFEEDING SYNDROME IN HIGH-RISK PATIENTS: IMPACT OF A SIMPLE VISUAL INTERVENTON

PD248

REDUCING REFEEDING SYNDROME IN HIGH-RISK PATIENTS: IMPACT OF A SIMPLE VISUAL INTERVENTON

V. Tournoij^1,*, K. Dams^1,2

¹Department of Clinical Nutrition, Antwerp University Hospital, Edegem, ²Laboratory of Experimental Medicine and Paediatrics (LEMP), Faculty of Medicine and Health Services, Antwerp University Hospital, Antwerp, Belgium

 

Rationale: When initiating total parenteral nutrition (TPN) in patients at risk of refeeding syndrome (RS), a reduced infusion rate is recommended. Although this instruction is documented in the electronic medical record (EMR), biochemical signs of RS were frequently observed during the first days of treatment. Evaluation revealed that the prescribed reduced infusion rates were not consistently followed.

To improve adherence, a simple visual tool (a red sticker with 'Abnormal infusion rate' on it) was attached to the TPN bag to clearly indicate the required deviation from the standard infusion rate.

Methods: A retrospective analysis was conducted for 2023^[1] (prior to implementation of the visual tool). Patients with a BMI < 18.5 kg/m² were identified as high risk for RS. Thirteen patients were randomly selected.

Serum phosphate and magnesium levels were collected at baseline and on days 1, 2, and 3 after TPN initiation. RS was defined as a decrease in phosphate of >30% from baseline or an absolute drop of >0.6 mmol/L.

Outcomes were compared with data from 2025^[2] after implementation of the visual tool where 13 patients were randomly selected. The selection criteria were strict (no children, no home PN patients, no double patients, time period from September to December). This resulted in a lower sample size.

Results: In 2023, 62% of high-risk patients developed confirmed RS.

After implementation of the visual tool in 2025, this decreased to 23%.

This represents a 39% absolute reduction in confirmed RS in this high-risk population.

Conclusion: The introduction of a simple visual aid significantly improved adherence to reduced TPN infusion rates and was associated with a marked reduction in RS.

A low-cost, practical intervention can substantially enhance patient safety.

References: 1. E. Mattheeussen, V. Tournoij. Annual TPN report 2023. 2024

2. E. Mattheeussen, V. Tournoij. Annual TPN report 2025. 2026

Disclosure of Interest: None declared