niaz-accreditation nutrition and dietetics• assessment of tpn indication according to eb...
TRANSCRIPT
‘non solum, sed etiam …’
‘niet alleen, maar ook …’netwerk AZ Sint-Lucas Brugge - AZ Zeno
NIAZ-Accreditation
Nutrition and dietetics
Dirk Bernard
medical director
AZ Sint-Lucas Brugge
Content
NIAZ standards
Legislation
Audit
Nutrition and accreditation: approach AZ Sint-Lucas
Brugge
Our projects and results
Evaluation
Current developments
Take home message
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NIAZ-accreditation and Nutrition
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THE PROCES
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NIAZ-accreditation and Nutrition
NIAZ: Dutch institute for accreditation in
healthcare (www.niaz.nl )
Audit standards 2.3
NIAZ Nutritional standard: just 1? 435.02
AND:
All general accreditation standards concerning
(hospital)management
Meeting legal obligations
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NIAZ Nutritional standard 435.02
Normelement 435.02
Normtekst De instelling werkt volgens de HACCP-richtlijnen/NEN-ISO 22000 bij het
inkopen, bereiden, verwerken, behandelen, verpakken, vervoeren, distribueren
en uitserveren van voedingsmiddelen en drinkwaren, waarbij zowel de
smakelijkheid en aantrekkelijkheid als de hygiëne en veiligheid zijn geborgd.
Toelichting
Categorie 4. Management van middelen
Subcategorie 3. Zorgondersteunende processen
Rubriek 5. Voedselvoorziening
Eis 3-4 Eis 3-4
NTA8009-2011
NZi Definities Veiligheid; Instelling
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HACCP: What and when?
Legal obligations:
Hazards Analysis Critical Controle Points (HACCP)
Allergens legislation 2014
What and When:
Preparation and distribution (central kitchen, ward kitchens,
wards, one day clinics, restaurant)
Storage of food and waste (kitchens, transportation)
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How?
Development, communication and implementation of
procedures
Monitoring compliance of procedures:
- Indicators
- External inspections (FAVV)
- internal audit and mini-audit?
Related standards
Prospective Risk Assessment (PRI)
Track & Trace
Performance areas (inspections, indicators, ...)
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Audit nutritional standard 435.02
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Nutritional procedure with control points
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Track and Trace Nutrition 2015
Reporting of an incident
Tracing source of incident by (electronic) meal
registration system
More possible victims?
Tracing and informing of supplier
Eliminating the source
Improving actions taken, implementation and
evaluation
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WHAT HAPPENED BEFORE
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Nutritional policy 2009-2015
AZ Sint Lucas Brugge
Situation 2009:
14.000 admissions / 415 beds
Malnutrition not addressed (dietitians not involved)
High Total Parenteral Nutrition (TPN) usage
Nutrition and dietetics: not part of the care process
Dietitians: in kitchen manager facility services
core tasks: administration kitchen, meal
distribution, HACCP, limited paramedic activities
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Projects Clinical Nutrition
2010: appointing a project leader/dietitian
managed by the medical director
Other initiatives:
2010: FOD-project Nutrition teams
2011: FOD-project Cancer plan:
1 onco dietitian (1 / 500 MOC’s (based on results 2008)
2014: FRKVA FOD Quality Indicator Malnutrition
2015: project tasks incorporated in legislation
-> KB 78 article 63 septies
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Organizational changes
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1. Projects:
- Malnutrition
- TPN
2. Introduction:
- electronic meal choice system
- electronic medical records
3. Project leader manager dietitians team
4. Dietitians moved from kitchen to clinic:
Malnutrition screening and treatment
Clinical nutrition (incl. TPN/EN) and ambulatory care
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Systematic approach
Example: malnutrition project
• Plan: procedure “Treatment of malnutrition”
• Do: tasks carried out by caregivers
• Check: evaluate results
discuss results with involved units
suggest improvements
inform nutritional management team
incorporate improvement actions in procedure
• Act: implement and monitor improvements
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Monitoring malnutrition screening:
results, goals and actions to improve
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Project 2: Total Parenteral Nutrition
(TPN) 2010-2011
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Project 2: TPN (a)
Tasks projectleader/dietitian
• Coordinator nutritional management team
• Detection of causes of high TPN usage
• Assessment of TPN indication according to EB guidelines
and nutritional needs and TPN advice by dietitian->
authorization of all medical specialists
• Start clinical nutrition team: monitoring of TPN/EN-patients
• TPN/EN protocols: approved by nutritional management
team
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Project 2: TPN (b)
Tasks projectleader/dietitian
• Monitoring usage nb of packs, users and costs TPN/EN
• Presentation of yearly TPN/EN usage to nutritional
management team, hospital management, medical and
nursing staff
• Providing continuing education on malnutrition and
clinical nutrition (EN and TPN)
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Results TPN usage
2009-2015
20
50% ↓ TPN usage and costs through follow up of TPN patients according to EB
guidelines by dietitians
0
20
40
60
80
100
120
2009 2010 2011 2012 2013 2014 2015Year
TPN costs compared to reference year 2010 (in %)
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0
1000
2000
3000
4000
5000
6000
2009 2010 2011 2012 2013 2014 2015
Year
Evolution usage nb of TPN packs/year(2009-2015)
van Schaik R, Niewold T.A. Quality improvement and cost savings by dietitians through follow-up of patients with total parenteral nutrition during hospital admission; e-SPEN Journal 9 (2014) e59-e62
27/02/2016
Conclusion projects
Essential role of dietitians as experts in disease related
(mal)nutrition, EN and TPN
Essential organizational changes: management decisions
Improved quality and safety of care by monitoring of TPN
(and EN) patients by dietitians
Cost savings
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After the projects?
Monitoring screening on malnutrition and treatment by
Electronic medical record (EMR)
TPN procedure and TP-EN instruction tools for caregivers
(physicians/dietitians) according to EB guidelines
2-yearly internal audit of nutrition and dietetics (critical
process)
Final assessment and NIAZ accreditation in 2015
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Current developments?
2016
Sharing knowledge : on the job training of dietitians teams
(nutrition teams) in follow up of TPN/EN-patients
Innovating multidisciplinary projects in collaboration with
physicians: low FODMaP and pre-dialysis in ambulatory
care,…
Introduction of electronic paramedical records (ICF codes)
in medical records (KWS) organized by UZ Leuven
Transition from NIAZ 2.3 to NIAZ-Qmentum
http://www.internationalaccreditation.ca/en/home.aspx
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NIAZ versus Q-Mentum
Nutritional standards?
Q-Mentum: no specific nutritional standards
Nutritional care:
is part of various standards in the total care process
is clarified in standard sets
e.g. screening on malnutrition risk and assessment of nutritional
and dietary needs
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Take home 1
Revalue the nutritional process as integral part of the
patients-based care process: from admission to discharge
Monitor the nutritional process (indicators) and critical
control points
Guarantee safe care in providing (dietary) nutrition, enteral
nutrition and parenteral nutrition
Provide an approved and communicated nutrition policy,
appropriate structure and organization (clinical dietetics /
nutritional management team / clinical nutrition team)
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Take home 2
Well-developed information network for procedures
and protocols available for/ communicated to all users
Continuing education about malnutrition and clinical
nutrition (EN and TPN)
Structural measurement of patient experiences,
complaints and incidents and monitoring improvements
Support of nutrition policy by management and medical
staff is essential!
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(Clinical) Nutrition is part of the care process!
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Questions?
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Johan Roose (quality coordinator): [email protected]
Rian van Schaik (manager dietitians team): [email protected]
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