Tailoring an Enteral and Parenteral Nutrition Handbook to the Standards of Care at an University Hospital

Abstract

Clinical nutritionists from both the medical and surgical nutrition support teams have developed a nutrition support handbook tailored to the standards of care at an university teaching hospital. The objectives for developing the handbook included: a) to promote consistent quality of care among nutrition support clinicians, b) provide a teaching tool for dietetic interns, c) orient new clinical staff, and d) serve as a resource for development and monitoring of continuous quality improvement (CQI) indicators. The handbook was divided into three main sections: Assessment, Enteral Nutrition, and Parenteral Nutrition. In order to provide information in a fast and easy manner, the organization emphasized tables, lists and bullet points rather than text. To decrease the length of the handbook, rather than including all the various possibilities, guidelines specific to our institution were listed, such as including protein in the calculation for calorie goal of parenteral nutrition. When there were differences in approaches by the two nutrition support teams, compromises were agreed upon, such as the protocol for tube feeding start rate. Multiple references were listed and appendixes were included. Final drafts were reviewed and approved by peers within the hospital. The result of this comprehensive effort is a useful tool for the education of dietetic interns, orientation of new staff, consistent quality nutrition care and a resource for CQI indicator development and monitoring.