NUTRITION SUPPORT TEAM. Consensus guideline for best practice in intestinal failure in paediatrics. John Puntis
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1 NUTRITION SUPPORT TEAM Consensus guideline for best practice in intestinal failure in paediatrics. John Puntis
2 Nutritional Support Team What is a Nutritional Support Team? nutrition is a multidisciplinary activity share expertise acknowledge different roles
3 Nutritional Support Team What does a team do? provide a comprehensive and coordinated approach to nutritional support reduce the prevalence of malnutrition develop protocols and guidelines for nutritional support (hospital and home) review and rationalise use of products act as an expert resource
4 Decreases Nutritional Support Team reliance on PN CVC placement complications CVC sepsis biochemical abnormality during PN malnutrition costs
5 Nutrition Support Team Aims to implement routine nutritional assessment in all children seen in hospital and identify those with (or at risk of developing) malnutrition to identify patients who require nutritional support to ensure provision of safe and effective nutritional management of patients
6 Nutrition Support Team Aims to plan home nutrition after discharge from hospital to educate hospital staff with respect to identification and management of nutritional problems to monitor and evaluate practice
7 Nutrition Support Team Potential benefits include reduction in: malnutrition nutrition support related complications length of hospital stay costs
8 Admission General assessment (weight; height; diet) nursing + medical staff does not need nutritional support Referral Risk of malnutrition nursing + medical staff (nutrition risk scores?) Nutrition Support Team Assessment Clinical Decision Administration
9 Any convincing arguments?
10 Nutrition Support Team Central venous catheter related sepsis significantly reduced by appointment of nutrition nurse (rigorous aseptic nursing care) adult and paediatric settings level of evidence 2+ recommendation: a nutrition nurse specialist reduces CVC sepsis - C
11 Nutrition Support Team Effect of NST on quality of nutritional care; reduces: PN waste unnecessary PN metabolic complications CVC related complications level of evidence 2+ recommendation - C
12 Nutrition Support Team Effect of NST on quality of nutritional care increases the chance of meeting nutritional targets in nutritional support decreases the risk of complications during home enteral nutrition level of evidence 2+ recommendation - C
13 Nutrition Support Team Effect of NST on quality of nutritional care NST that are advisory are less effective than NST that initiate and manage nutritional support level of evidence 3 recommendation - D
14 Nutrition Support Team Educational interventions and feeding algorithms: targeted staff education and feeding algorithms improve nutritional support decrease unnecessary PN reduce costs of nutritional support level of evidence 2+ recommendation - C
15 Nutrition Support Team Costs NST reduce the costs of nutritional support level of evidence 2+ recommendation C
16 Nutrition Support Team Good clinical practice nutritional assessment and intervention in paediatric units should be supervised by a multidisciplinary NST with specialist nutrition nurse as a core member the NST should be autonomous with respect to choice of PN or enteral nutritional support the NST should audit its activity including the use of short (<5 day) courses of PN, and complications of nutrition support (particularly CVC sepsis)
17 The Nutritional Care Team Which staff make up a team? clinical nutrition nurse specialist cost savings CVC sepsis; home care pharmacist, paediatrician, dietitian, surgeon speech and occupational therapists biochemist, interventional radiologist, etc.
18 PN usage by speciality over 3 months the General Infirmary at Leeds PN days 2012: approx PN days/year
19 Who do you want prescribing? or
20 Prescribing parenteral nutrition Doctor v. Pharmacist for Rx Neonatal PN System Dr. time (mins) Interruptions (n) Processing time (mins) Enquiries (n) Use of NSI Alterations (n) * * * * * * Dr. Pharm. saving * significant at p = 0.05; NSI = non standard ingredient
21 staff time financing maintaining budgeting control lack of awareness lack of interest lack or priority lack of time Justification of the team Doctors Barriers Health care organisation Team framework change confusion ineffective communication purchaser/provider structure conflicts of interest Barriers to establishing a nutrition team
22
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