Home Start Parenteral Nutrition: What Home Infusion Clinicians Need to Know for Best Practice and Patient Safety - INFUSION Article

The initiation of parenteral nutrition (PN) in the home setting, often referred to as "home start PN," offers significant benefits for patients who require PN therapy but have no other indications for hospital admission. While home parenteral nutrition (HPN) has been utilized since the late 1970s and has evolved significantly, clear, standardized guidelines for initiating PN at home remain lacking. This process demands specialized expertise and adherence to specific protocols. This article equips home infusion clinicians, including pharmacists, pharmacy technicians, nurses, and dietitians with a comprehensive framework for the safe and appropriate initiation of HPN. It covers essential aspects such as competency, training, and education requirements for all disciplines involved in HPN care. The article also examines criteria for determining when home initiation is suitable, along with the risks and potential disadvantages of starting PN in the home setting. Additional topics include insurance coverage considerations, clinical criteria for PN, the referral process, PN formulas, patient-specific goals, cycling, and ongoing patient monitoring. To enhance practical understanding, the article features a case report and addresses considerations for specific patient populations.

Learning Objectives:

  1. Discuss considerations for safe initiation of parenteral nutrition (PN) in the home setting.
  2. Review referral process and the importance of interdisciplinary team communication.
  3. Establish appropriate PN care plans with safe advancement from initiation to goal.
  4. Describe required clinical monitoring through the duration of home PN therapy.

NHIA General CE Information

Lisa Kinder, RD, CNSC

Lisa Kinder, RD, CNSC

Clinical Program Manager

Optum Infusion Pharmacy

Lisa Kinder is a registered dietitian, maintains certification as a nutrition support clinician, and has worked in the home infusion setting since 2004. She is a clinical nutrition program manager at Optum Infusion Pharmacy. Her current role focuses on training and education programs for clinicians providing home parenteral nutrition. She is passionate in the areas of safe parenteral nutrition initiation in the home setting and the prevention of refeeding syndrome. Lisa has co-authored publications including abstracts, continuing education articles, a white paper, and has presented posters and educational sessions at national conferences including ASPEN and NHIA. She serves on NHIA’s Education Committee. Lisa received UnitedHealth Group’s Sages of Clinical Services Award in 2019, is a member of the home nutrition support team that was honored with ASPEN’s Clinical Nutrition Team of Distinction Award in 2022, received ASPEN’s HPEN Trailblazer Award in 2023 and became a NHIA Fellow in 2025.

NHIA Requires planners, faculty, and others who affect the content of this activity to disclose all financial relationships they have with ineligible companies. All relevant financial relationships are thoroughly vetted and mitigated according to policy. 

Lisa Kinder has no relevant financial relationships with ineligible companies to disclose.

Shirley Au, RD, CNSC

Shirley Au, RD, CNSC

Sr Nutrition Support Dietitian

Optum Infusion Pharmacy

Shirley Au, RD, CNSC is a Senior Nutrition Support Dietitian at Optum Infusion Pharmacy. She has extensive experience in home infusion, specializing in home nutrition support patient care management and business development. She is passionate about providing the best care to patients on home PN. She began her home infusion career in 2004 and has held leadership positions with several national providers. Au has published several journal articles, presented ASPEN podcast, NHIA webinar, as well as posters and conference presentations at ASPEN and NHIA. Au and her colleagues were awarded ASPEN Clinical Nutrition Team of Distinction in 2022. She was also honored by her peers as Clinician of the Year in 2010, Dietitian Top Performer in 2017, and a recipient of UnitedHealth Group Sages of Clinical Services Award in 2023.

NHIA Requires planners, faculty, and others who affect the content of this activity to disclose all financial relationships they have with ineligible companies. All relevant financial relationships are thoroughly vetted and mitigated according to policy. 

Shirley Au has no relevant financial relationships with ineligible companies to disclose.

Yvette Jones, MS, RDN, LD, CNSC

Yvette Jones, MS, RDN, LD, CNSC

Regional Nutrition Manager

Optum Infusion Pharmacy

Yvette Jones, MS, RD, LDN, CNSC is a Regional Nutirition Manager for Optum Infusion Pharmacy based in Florida. She is a registered dietitian and Certified Nutrition Support Clinician with 30 years of diverse nutrition experience including clinical nutrition, operations/management and home infusion sales specific to nutrition support. In her current role she serves as a subject matter expert, providing in-service trainings and continuing education on PN, assists with reimbursement activities related to PN coverage, and provides training for new acute sales team and clinical liaisons.

Before practicing in the home site of care, Jones worked in nutrition support in a variety of settings, icnluding skilled nursing facilities and long-term care. She has published numerous articles and posters for NHIA and ASPEN. Jones was nominated as an Optum Superhero in 2019 and named the President's Club regional Nutrition Manager in 2021. 

NHIA Requires planners, faculty, and others who affect the content of this activity to disclose all financial relationships they have with ineligible companies. All relevant financial relationships are thoroughly vetted and mitigated according to policy. 

Yvette Jones has no relevant financial relationships with ineligible companies to disclose.

Penny Allen, RD, CNSC, FASPEN, FNHIA

Penny Allen, RD, CNSC, FASPEN, FNHIA

VP of Nutrition Support Services, Retired

Optum Infusion Pharmacy

Penny Allen, RD, CNSC, FASPEN, FNHIA recently retired as the Vice President of Nutrition Support Services for Optum Infusion Pharmacy. Penny began her nutrition support career at Beth Israel Hospital in Boston, Massachusetts after obtaining her nutrition degree from the University of New Hampshire. She has spent over 30 years in the home infusion setting in a variety of roles, eventually as the nutrition support lead for Optum Infusion Pharmacy driving state of the art nutrition support care based on ASPEN standards and excellence in home nutrition support. Allen is a Certified Nutrition Support Clinician (CNSC), serves as Immediate Past Chair of the ASPEN Public Policy Committee, current Chair of the National Home Infusion’s Medicare Contractor and Advisory Committee and is a published subject matter expert in Medicare PN and EN policies and other home nutrition support related topics. Her career passion is improving access to quality nutrition support therapies for all patients.

NHIA Requires planners, faculty, and others who affect the content of this activity to disclose all financial relationships they have with ineligible companies. All relevant financial relationships are thoroughly vetted and mitigated according to policy. 

Penny Allen has no relevant financial relationships with ineligible companies to disclose.

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