Nutrition Support Team: Role of Dietician and Nursing: Nestle

Speaker: Dr. Bhuvaneshwari Shankar - Group Chief Dietitian, Apollo Hospitals Presented at: CRITICARE 2011 New Delhi, Workshop on Nutrition in Critical Care

Summary

Nutrition support professionals (NSP) are dieticians, pharmacists, nurses, and physicians who are specialists in providing and managing enteral and parenteral nutrition in diverse patient populations, from paediatrics to geriatrics. NST should be a role model for multi-professional working. It brings together nutritional experts from medicine/surgery, nursing, dietetics and pharmacy that can coordinate the contributions of each of these specialties into coherent nutritional support. It manifestly cannot do all the ward delivery of nutritional care itself, hut serves to organise it and enhance it.

Principles of chronic disease management require patient and health providers to work as a team and demands consistent relationship between patient and health care team members. It also requires regular interdisciplinary care team meetings to discuss care issues, review treatment protocols, express concerns and support colleagues. Nutrition support physicians lead the nutrition care implementation structure in many institutions. These physicians must be familiar with all aspects of nutrition care, including patient screening, assessment, development and implementation of a nutrition care plan, patient monitoring and termination of therapy. Nutrition support physicians supervise care provided by dieticians, nurses and pharmacists, and engage in all aspects of direct care of patients’ nutrition needs as indicated.

The responsibilities of a nutrition support nurse vary with the practitioner’s educational background, position and practice environment. The scope of practice includes but is not limited to the following directing patient care including intravenous access; educational patients and caregivers and participation in research activities. The dietician’s key role is collaboration with the nurses in assessing and monitoring nutrition intake and to look at deficiencies in diet, suggest supplemental sip’ feeds and choice of EN feeds. At the proficient stage (Specialty level), the RD has developed a deeper understanding of nutrition support therapy and is much better equipped to apply best practice and evidence-based principles. This RD is also able to modify practice according to unique situations. At the Expert stage (Advanced level), the RD thinks critically about nutrition support therapy, exhibits a range of highly developed clinical arid technical skills. Formulating judgments based on a combination of experience and education.

Nutrition support pharmacists compound the parenteral nutrition formulation prescribed and provide direct patient care, in addition to this, they manage the specialized nutrition support program and improve quality by educating other health care professionals, students, patients and caregivers. Many pharmacists also conduct research or participate in research activities. There are various benefits to NST’s, according to Ireton-Jones, the data showed decreased length of therapy, decreased days of hospitalization and rehospitalisation, an increase in ways to improve eating and tolerate food better, reduction of nutrition support needs, and increased quality of life. The results were published in an abstract in nutrition in Clinical Practice. Identify an implementation group, raise awareness of the guideline recommendation among all staff directly involved in patient care include nutrition support within induction programmes, identify staff training needs and provide training using externally commissioned and ‘in-house’ programmes and review service protocols and care pathways.