26. Identification of Food Insecurity and Interdisciplinary Team Interventions in Home Parenteral Nutrition Patients

Background: Food insecurity is when people do not have enough food to eat and do not know where their next meal will come from. In the United States approximately 49 million people relied on food assistance charities in 2022 (data from Feeding America). Patients receiving parenteral nutrition (PN), who may be capable of supplementing with oral intake, may experience food insecurity due to chronic health conditions limiting work capability and total family income. Patients may also experience lack of affordable housing, increased utilities and the burden of medical expenses.

Purpose: Signs of food insecurity may present as weight loss, malnourishment, low energy, difficulty concentrating, or other physical indicators such as edema, chronically cracked lips, dry skin, and itchy eyes. The purpose of this abstract is to highlight two unique patient case presentations where food insecurity prompted clinicians to intervene.

Methods: Patient 1: 50-year-old male with short bowel syndrome (SBS) on long-term PN called the dietitian regarding financial difficulties with feeding the family. The patient and clinician relationship allowed the patient to convey sensitive concerns to the registered dietitian (RD) regarding inability to feed himself and his family, which resulted in the patient relying on the PN for all nutrition. Due to the food insecurity present, the clinician made changes to PN/hydration to help improve patient’s clinical status.

Patient 2: A 21-year-old male with SBS on long-term PN spoke with his in-home registered nurse (RN) regarding family’s difficulties affording food. The RN informed the clinical team of suspected food insecurity and the insurance case manager (CM) was contacted regarding food affordability. The RD reached out to local community resources such as food banks, food boxes and community programs. A community program was able to assist the patient with meals until patient’s aunt started cooking meals for him. This patient did not directly share food insecurity with RD; however, the relationship with the in-home RN proved valuable in having these face-to-face conversations with the patient.

Results: In these two patient examples, difficulty obtaining food affected the patients’ clinical status. The clinical team identified food insecurity and the need for further education for the interdisciplinary team. A food insecurity informational handout was created by the RD with an in-service to nursing to help aid recognition of signs to detect possible food insecurity, potential patient resources available in the community, and suggested questions to ask if an issue is suspected.

Discussion: Given the prevalence of food insecurity, routine assessment for signs and symptoms is essential. Home nutrition support teams (including RDs, RNs, pharmacists and care technicians) are positioned to assist in this effort as they have frequent phone and in-home contact with patients and together build a trusted relationship with patients and caregivers. Clinicians should be aware regarding potential social situations which can warrant changes to PN formulations.

Conclusions: To approach this sensitive issue thoughtfully, PN infusion providers should consider enhancing patient assessments and promote education across the interdisciplinary team to create awareness of accessible community resources.