Enhancing Patient Safety in Home Parenteral Nutrition

Abstract

Parenteral nutrition is vital for some patients, but it carries risks such as catheter-related infection. When parenteral nutrition is administered at home (HPN: home parenteral nutrition), patients often remain dependent on professional care support. Digital assistive technologies may enhance safety during HPN care while also promoting patient autonomy. This study presents a mobile digital assistant application that provides step-by-step guidance for routine HPN administration and support in emergency situations. The application was developed iteratively based on the expertise of care professionals, focus-group findings, and a structured risk analysis. Its usability and safety support potential were evaluated by twelve nursing professionals with HPN expertise. Participants completed a guided 12-step HPN workflow. Usability was assessed using a Cognitive Walkthrough (CW), based on Spencer’s 3-point scale (0 = no problem, 1 = potential problem, 2 = clear problem), and the System Usability Scale (SUS). Qualitative remarks were thematically analysed. Across 576 CW ratings, 88.7 % received a score of 0, 7.7 % a score of 1, and only 3.6 % a score of 2, representing an improvement over the internal pilot (55 % and >15 %, respectively). Residual problems mainly concerned hygiene and visual confirmation of successful infusion (dis)connection. The mean SUS score was 80.4, indicating good to excellent usability. Thematic feedback highlighted the app’s clear visual guidance and suggested optional voice control, extended multimedia instructions, and sensor-based air-bubble alarms. Expanded expert testing indicated that the app addressed most critical usability and safety support issues identified in earlier development stages. The mobile digital assistant application showed promising usability and safetysupport potential for guiding routine and emergency-related steps in HPN care. Next steps include integration with electronic health record systems and field evaluation with patients in real home settings to explore potential effects on HPN safety and autonomy.