NUTRITION SUPPORT TEAMS: CLINICAL PRACTICE

K. Boeykens (BE)

ESPEN Congress Copenhagen 2016THE NUTRITION SUPPORT TEAM: 'TWO AND TWO EQUALS FIVE'

Nutrition Support Team

AZ Nikolaas- Belgium

Kurt Boeykens

CNNS

Learning objectives

• Nutrition support teams: Clinical practice

• Be able to illustrate through clinical practice

examples how a NST can enhance

(nutritional) patient care

• Understand how nutritional care can be

brought to a higher level with a intensified

multidisciplinary approach

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3

2006

NST

• The multiprofessional team of physician, specialist nurse,

dietitian and pharmacist can do much to co-ordinate the

nutritional function of ward nurses, ward dietitians, ward

pharmacists and other physicians in the delivery of an

organized nutritional strategy.

• AZ Nikolaas:

• Specialist nurse(s): 2 (one = co-ordinator NST)

• Dietician(s): team

• NS pharmacist(s): 3 (TPN)

• NS physician: 1 (GE)

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The roles in a NST

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8

NS Dietician

NS Pharmacist

NSN

NS Physician

MD ward rounds

• Started weekly

• Selected patients (TPN, complex EN, ICU)

• Ad hoc

• Telephones daily:

• Pharmacy-dieticians-NSN-Speech therapists-

physicians

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Liaison

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Intramural liaison

• Dietetics

• Pharmacy

• Nursing teams

• Nursing management

• Lab

• Physicians

• Endoscopy

• PST/OST

• GST

• Diabetic team

• Radiology

• Consultations

• Social services

• ICT

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Extramural liaison

• Home care providers

• General physicians

• Home care nurses

• Home NST

• Patient organizations

• Insurance companies

• Nutrition companies

• Nutrition societies

• Government

• Expert/workgroups

• Discussion forums

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Steering Committee

• General advise and discussion on all aspects of nutrition in the hospital = POLICY

• Members of different departments• Hospital staff: nursing director, medical director

• Head dietician

• NS pharmacist (1) and head pharmacist

• Speech therapist

• Medical staff

• NS physician

• CNNS (co-ordinator NST)

• Meeting every 3-4 months

How did we start?

1. Who took the initiative?

2. Setting priorities: ‘road map’

3. First act?

4. Financial support

Initiative

• 2000

• Gastroenterologist

• Nutritional education/background/interest

• After ‘diplomatic survey’:

• dieticians

• ‘hotel manager’

• nursing director

• some surgeons, intensivists, physicians

Priorities

• Appointment of a CNNS/NSN

• Co-ordinator

• Establish Steering Committee and NST

• Road Map: education, protocols, qualityprojects, malnutrition pathway,…

• Nutritional benchmarking

• Ex. Use of TPN

• 2000: TPN questionnaire:

• 75 questions on all aspects of TPN

• Head nurses of all nursing departments

• Intentions:

• Introducing the nutrition support nurse

• Collecting data to help persuade management

• Identifying problems

• Tool for quality control

• Feeding line used for other purposes?

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2

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5

0

0,5

1

1,5

2

2,5

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3,5

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4,5

5

never rarely frequently always

n = 15

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TPN questionnaire: conclusions

• No protocols or standards

• Every ward has its own ‘traditions’

• Some intolerable situations!

• Urgent need for protocols and

teaching

Financial support

• Small amount of money from the

government (pilot project NST)

• +/- 20.000 euro’s/year

• CNNS = funded by the hospital

• NST

• Fixed yearly budget for education, special

equipment, quality projects,….

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Our NST

Translation of nutritional evidene or

care into clinical practise

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• Specific protocol to identify at risk patients

• Rapid and simple

• Proces of re-screening

• Assessment

• NCP

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Who was involved?

• Head nurses and ward nurses

• Nutrition reference nurses

• Head nursing departement

• Dietetics

• ICT and private software company

• Quality co-ordinator

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Step 1

• Task manager: automatic list of all patients

who need a nutrition screening after

admission

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Step 2

• Full NRS-based and how the patiënt is

measured

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• Disease scores:

• ICU, internal medicine and surgery

• 1,2 or 3 points

Next steps

• Software:

• Generates total NRS score

• Asks for a nutritional assessment (only on the

PC’s of the dieticians, NSN) if NRS ≥ 3

• Asks for a NCP if at risk or malnourished

• Asks for a rescreening after a week

• Food intake, weight

• Transfers data to the individual patient file:

weight, length, BMI and how measured

• Software remembers the length for one year

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NUTRITION DAY

AZ NIKOLAAS

Goals• Participation in the Worldwide Nutrition Day

• General sensitization for malnutrition in our hospital (main goal).• Intra muros screening of all patients

• Extra muros (press conference, radio, newspapers, television)

• Broad participation of wards and health care workers (nurses, dieticans, doctors, management, kitchen staff…)

• Special activities to support the main action.

• Data collection and analysis

LogoEating better = recovering

quicker

The NST is here for you

BMI measurements hospital staff

Fresh fruit juice

Donuts

Ambiance

2006

Breaking news!

Patients

• Flyer

• Special dessert

At risk

n

Risk

PEG-placement

From (contra) indications to home

care follow-up

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Co-ordination by the NST

1. All patients are assessed by the NST

2. Rule out (contra) indications

3. Check-list to prepare patients

4. All PEG’s are placed by the CNNS

5. After care is done/supervised by the

CNNS

6. Transmural care/follow-up (HEN)

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2005

Pre-op assessment

• Identify at risk patients or not suitable patients

• Refer at risk patients to a pre-op consultation (head &

neck cancers)

• Establish proper preparation/information/problem-solving

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2016

After-care

• Database

• Complications, duration (H)EN therapy,

removal technique,….

• Transmural care

• Discharge letter with all aspects of HEN

therapy for home care nurses and physician

or for nursing homes

• Problem-solving

• Telephone, mail or website

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HPN

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HPN

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Baxter

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