Nutrition Support Team Research Articles

Effectiveness of a multidisciplinary team for nutrition support in a trauma intensive care unit.

BackgroundWe evaluated clinical and nutritional outcomes according to multidisciplinary team involvement in nutrition support in a regional trauma intensive care unit (TICU).MethodsWe retrospectively compared the outcomes for 339 patients admitted to the TICU for >5 days depending on nutrition support team (NST) involvement (n=176) and non-NST involvement (n=163).ResultsThe mean age and injury severity score (ISS) were 57.3±16.7 years and 18.6±9.7, respectively. Fifty-three patients (15.6%) had shock on admission and 182 (53.7%) underwent surgery during TICU admission. Some patients were admitted to neurosurgery (46%), general surgery (35.4%), and other (18.6%) departments. There were significant differences in the ISS, Acute Physiology and Chronic Health Evaluation (APACHE) II score, shock on TICU admission, and initial laboratory results. After propensity score matching, the total delivered/required caloric ratio and total delivered/required protein ratio were significantly higher in the NST group than in the non-NST group (calorie: 80.4% vs. 66.7%, P=0.007; protein: 93.1% vs. 68.3%, P<0.001). The NST group had an adequate protein supply more frequently than the non-NST group (protein: 48.0% vs. 25.8%, P=0.002). There was no significant difference in survival, even after adjustment for risk factors using Cox proportional hazard analysis.ConclusionsThe results of our study suggest that multidisciplinary team involvement in nutrition support in TICU patients may improve nutritional, but not clinical, outcomes.

Modern Challenges to Gastrointestinal Nutrition Physicians and the Nutrition Support Team: Cautionary Tales and Call to Action.

The current climate of healthcare economics in the United States has imposed unprecedented market stressors on health institutions traditionally providing tertiary care to those with the most challenging healthcare needs. In such a stressed financial atmosphere, administrators look to streamline costs and cut margins as tightly as possible. This often results in restructuring, consolidating, or closing service lines that are perceived as unprofitable or unsupportable. Nutrition support often falls into this category because of few sources of direct revenue-generating activities and poor reimbursement from third-party payers. This article discusses the challenges to modern nutrition support teams, particularly those with gastroenterologists as physician leaders, and delineates market forces that need shifting to continue to make this a viable part of the healthcare system.

SARC-F as a Screening Tool for Sarcopenia and Possible Sarcopenia Proposed by AWGS 2019 in Hospitalized Older Adults.

The SARC-F questionnaire is a sarcopenia screening tool. However, the validity of the SARC-F score ≥4 (SARC-F≥4) for the evaluation of sarcopenia in the hospital setting has not been investigated. This study investigated the validity of SARC-F≥4 as a screening tool for sarcopenia among hospitalized older adults. Cross-sectional retrospective study. A university hospital. This study included older adult patients (age ≥65 years) who were hospitalized at, and subsequently discharged from, the hospital between April and September 2019 and underwent a nutritional assessment by the nutrition support team during their hospitalization. SARC-F was recorded at the time of admission, and the criteria specified by the Asia Working Group for Sarcopenia in 2019 (AWGS 2019) were applied to diagnose sarcopenia and possible sarcopenia. Appendicular muscle mass was estimated through validated equations, and three different models were developed for sarcopenia diagnosis. The sensitivity, specificity, and positive/negative likelihood ratios were calculated to analyze the accuracy of the SARC-F≥4 for sarcopenia and possible sarcopenia. Receiver-operating characteristic analyses were conducted to calculate the area under the curve (AUC). In total, 1,689 patients (mean age: 77.2±7.3 years; male: 54.4%) were analyzed, and 636 patients (37.7%) had SARC-F≥4. Patients with SARC-F≥4 had a statistically significant higher prevalence of AWGS 2019-defined sarcopenia than patients with SARC-F <4 in the models (65.4-78.9% vs 40.9-45.2%, p<0.001). The sensitivity, specificity, and positive/negative likelihood ratios of SARC-F≥4 for sarcopenia and possible sarcopenia were 49.1-51.3%, 73.9-81.2%, and 1.88-2.72/0.60-0.69 and 48.0%, 84.5%, and 3.11/0.62, respectively. The AUC for sarcopenia and possible sarcopenia were 0.644-0.695 and 0.708, respectively. The AUC of SARC-F for possible sarcopenia was equivalent to or larger than that for sarcopenia (DeLong test p=0.438, 0.088, and <0.001 vs the three models). SARC-F≥4 is suitable as a screening tool for sarcopenia in hospitalized older adults. SARC-F assessment could facilitate the detection and exclusion of sarcopenia at hospitalization and may lead to early adoption of a therapeutic and preventive approach.

The Influence of Pediatric Nutrition Support Team on Hospitalized Pediatric Patients Receiving Parenteral Nutrition

The Influence of Pediatric Nutrition Support Team on Hospitalized Pediatric Patients Receiving Parenteral Nutrition

Nutritional Support Team Approach Decreases the In-Hospital Mortality Rate after Deceased Donor Liver Transplantation

Sang-Oh Yun, M.D., Jong Man Kim, M.D., Ph.D., Sangjin Kim, M.D., Jinsoo Rhu, M.D., Hyun Jung Kim, M.S., Soo Hyun Park, M.S., Hyo Jung Park, M.S., Eunmi Gil, M.D., Wonseok Kang, M.D., Ph.D., Gyu-Seong Choi, M.D., Ph.D, Won Hyuck Chang, M.D, Ph.D., Jeong-Meen Seo, M.D., Ph.D., Jae-Won Joh, M.D., Ph.D.. Surg Metab Nutr 2020;11:7-11. https://doi.org/10.18858/smn.2020.11.1.7

Nutrition Support Team Oversight and Appropriateness of Parenteral Nutrition in Hospitalized Adults: A Systematic Review.

Inappropriate parenteral nutrition (PN) administration often occurs in hospitalized patients, increasing the risk of complications. Nutrition support teams (NSTs) regulate and approve PN use in some hospitals. This systematic review examined whether appropriateness of PN use in hospitalized adult patients increased under NST oversight. Ten databases were searched systematically to select studies from 2004 to 2020 that analyzed appropriateness of PN use in adult hospitalized patients under NST oversight. Studies were included if appropriateness of PN was examined and NSTs were involved in PN orders or recommendations. Studies were evaluated using the Quality Criteria Checklist from the Academy of Nutrition and Dietetics Evidence Analysis Library. Nine studies were included in the final analysis. One received a positive rating on the quality checklist, whereas 8 received a neutral rating. Inappropriate PN use varied from 4.3% to 18%. Two studies compared PN use between multiple hospitals, both with and without NSTs. Two compared appropriateness before and after NST implementation, whereas another 2 studies compared it before and after NST restructuring. Three studies examined appropriateness of PN with NST oversight at a single facility with no control group. Overall, NSTs were associated with decreased incidence of inappropriate PN use. No studies were randomized, and several did not describe demographics between groups. Although NSTs appear to decrease inappropriate PN use, the results are limited because of study design or reporting. Future studies should monitor and evaluate clinical outcomes, such as mortality, and utilize more rigorous methodologies.

Enteral Nutrition Administration Record Prescribing Process Using Computerized Order Entry: A New Paradigm and Opportunities to Improve Outcomes in Critically Ill Patients.

Prevalence of malnutrition has been reported in 60% of hospitalized and up to 78% of patients admitted to intensive care units. Malnutrition has been associated with complications, such as infection, increased hospital length of stay, morbidity, and mortality. Nutritional support has been shown to reduce avoidable readmissions, pressure ulcers, malpractice claims, and hospital costs. Creating a new electronic nutrition administration record (ENAR) with a linked nutrition tab within the electronic health record (EHR) would promote enhanced patient outcomes by improving adherence to established institutional enteral nutrition (EN) protocols and achieving early energy goals. Additionally, it would enable a clear and standardized method for documentation and administration of EN therapy. The multidisciplinary nutrition support team was established and met on a weekly basis to discuss strategies and barriers, identify stakeholders, evaluate the current state, and establish a process and workflow from the point of order entry, delivery, administration, and electronic documentation of orders of EN supplements. The aim of this article is to describe a systematic approach and process of creating a new ENAR with a linked nutrition tab in the EHR, and to illustrate the order panel built and lessons learned from the process. A separate nutrition tab was created in the EHR with minimal disruption in patient care and end-users' positive feedback for the new order panel. ENAR allows for easier data collection and promotes nutrition-related research that may result in enhanced patient care. Utilizing technology to build a full ENAR would result in optimized patient care and safety.

Nutrition Support Team Reconsultation During Nutrition Therapy in Korea

The aim of this study was to investigate the nutrition support team (NST) reconsultation practice and to evaluate reasons and describe risk factors for NST reconsultation during nutrition therapy (NT) in hospitalized patients. This study included 2505 patients aged >18 years who received NT through NST consultation between January 2016 and December 2016 at Seoul National University Hospital. NST reconsultation refers to consulting the NST more than twice during a single hospitalization period. Risk factors affecting NST reconsultation were included only when NST reconsultation occurred for specific reasons other than routine evaluations. The NST reconsultation rate was 36.4% (913/2505) with 926 reasons, including 'changes in the nutrition provision method' (n = 474, 51.2%), 'NT-related complications' (n = 284, 30.7%), 'routine evaluations' (n = 137, 14.8%), and 'discharge planing including home NT' (n = 31, 3.3%). The reconsultation rate of enteral nutrition (EN) was 40.8% (n = 378) and that of parenteral nutrition (PN) was 59.2% (n = 548). Among the NT-related complications, diarrhea (n = 65, 49.2%) was the most common with EN, whereas electrolyte abnormality (n = 52, 34.2%) was the most common with PN. Performance of surgery (odds ratio [OR], 2.061; P < .001), low serum albumin levels (<3 mg/dL; OR, 1.672; P < .001), presence of comorbidities (OR, 1.556; P < .001), and low body mass index (kg/m2 ) (<18.5; OR, 1.508; P < .001) were predictive risk factors for NST reconsultation. Frequent evaluation of nutrition status through a multidisciplinary NST is important in patients with these risk factors.

Características clínicas de los pacientes con nutrición parenteral en el Hospital de Especialidades Pediátricas Omar Torrijos Herrera, Panamá

El paciente pediátrico se caracteriza por ser más sensible a las restricciones energéticas y de nutrientes. Los equipos de soporte nutricional han optimizado la práctica nutricional intrahospitalaria.

Impact of Nutrition Support Team on Postoperative Nutritional Status and Outcome of Patients with Congenital Gastrointestinal Anomalies.

BACKGROUND The aim of this study was to evaluate postoperative nutritional status in patients who underwent operations due to congenital gastrointestinal anomalies in surgical neonatal intensive care units (NICUs) and to investigate the role of nutrition support teams (NSTs) on the outcome. METHODS A retrospective clinical study was carried out at two NICUs in Dr. Sheikh Pediatric Hospital, Mashhad, Iran. One of the NICUs was supported by NST and the other was not. A total of 120 patients were included through a non-random simple sampling. Different variables such as age, sex, prematurity, type of anomaly, birth weight, use of vasoactive drugs, weight gain in NICU, length of NICU stay, postoperative enteral nutrition initiation, duration of mechanical ventilation, mortality rate, maximum of blood sugar, the amount of calorie delivered to the calorie requirement ratio, and distribution of energy from enteral or parenteral roots were compared between the patients of two NICUs. RESULTS Median weight gain and the amount of calorie delivered during NICU stay in subjects of NSTsupported NICU was significantly more than other NICU. There was no significant difference in the length of NICU stay, enteral nutrition initiation after the operation, ventilation days, and percent of mortality between the two groups. The percentage of enteral feeding was also increased by about 2.8%, which was not significant. CONCLUSION NST could increase post-operative weight gain and calorie delivery in patients as well as providing an increase in enteral feeding rather than parenteral.

Nutrition Support Teams: A Systematic Review.

The concept of a nutrition support team (NST) was first introduced at the end of the 20th century in the US and Europe. Expected benefits include reduced (inappropriate) prescription of (par)enteral nutrition; however, to the authors' knowledge, no recent review has assessed the effectiveness of NSTs. Therefore, this systematic review evaluated the effectiveness of NSTs with respect to the prevalence of adult patients receiving (par)enteral nutrition. Five literature databases were searched and completed by citing searches. Studies on NSTs that were published between 2000 and 2018 in Western countries, applied a comparative design, and contained at least outcome data on the prevalence of (par)enteral nutrition were included. Analyses were mainly descriptive because of high heterogeneity that prevented meta-analyses. The 27 included studies mainly originated from the UK and US. Only 1 of the included studies was a randomized trial; the other studies had a pre-post design (n = 17) or compared groups in a nonrandomized way. All but 2 studies were performed in acute care hospitals, and 5 studies focused only on intensive care patients. There was conflicting evidence of whether NSTs lead to reduction or increase in patients starting parenteral nutrition (PN); however, weak evidence suggested that NSTs might lead to an increase in the ratio of enteral nutrition to PN use and might decrease inappropriate PN use. Although almost all studies concluded in favor of NSTs, the evidence base is weak and insufficient because of a lack of well-designed studies and successful outcomes.

Knowledge and competencies regarding artificial nutrition among ward nurses and doctors: results of a pilot questionnaire

Background: Ward staff often lack basic nutritional knowledge in the care of artificially fed patients. Clinical guidelines and training aim to improve nutritional perceptions and maintain patient safety. Aim: To evaluate the level of nutritional knowledge and competencies among ward staff and improve the standard of teaching available to healthcare professionals. Method: A staff questionnaire was piloted to measure content validity and evaluate study objectives. Nine questions were thought to be essential standards in the care and management of both enteral and parenteral patients. Four multiple-choice and five open-ended questions were used. Results: A 100% response rate was achieved from nine nurses and one doctor. They had been qualified for an average of 3.3 years (range 1–6, median 2), and their nutritional knowledge was defined as acceptable. Conclusion: Guidelines and recommendations were not being implemented, and nutritional care of patients was a low priority. Health professionals need to be more aware of the role of the nutrition support team to prevent role ambiguity.

The Ideal Role of Pharmacists: A Nurse's Perspective

Drug-related work is one of the most difficult tasks for nurses. This may stem from the lack of knowledge of pharmacology as the minimum duration of the pharmacology course in basic nursing education is only 30 h (2 units). According to the Project to Collect Medical Near-miss/Adverse Event Information 2018 Annual Report of the Japan Council for Quality Health Care, 9.2% of incidents were related to medication and the majority involved nurses. Several medication management tasks in hospitals are currently managed by nurses, while at the same time many nurses have high expectations of pharmacists as experts in pharmacology. Nurses recognize that pharmacists working in hospital wards have great responsibilities. Furthermore, in hospitals that promote advanced treatments, the expertise of pharmacists is demonstrated in the fields of chemotherapy and palliative care in cancer treatment, infection control, and nutrition support team (NST). In many hospitals, however, nurses are responsible for several medication management tasks. Therefore, nurses believe that it would be beneficial for pharmacists to participate more in medical management tasks.

When is parenteral nutrition indicated in the hospitalized, acutely ill patient?

The current review discusses current practices regarding appropriate indications for parenteral nutrition in acutely ill hospitalized patients. We address-specific indications for parenteral nutrition in the perioperative period, and in inflammatory bowel disease, oncology, hepatobiliary, critical care and end-stage renal disease patients. Acutely ill hospitalized patients can develop intestinal failure requiring parenteral nutrition. Recent studies have provided insight into the main indications. The most common indications for inpatient parenteral nutrition include postsurgical complications, including prolonged ileus, sepsis, fistula and leaks, and bowel obstruction, predominantly malignant. Severe or complicated inflammatory bowel disease and cancer treatment-related mucosal enteropathies (mucositis, enterocolitis, gut graft-versus-host disease) are the next commonest indications. Less frequent indications are primary motility disorders and inability to secure enteral access for enteral nutrition. Gastrointestinal failure of the intensive care patient is a separate entity resulting from multiple mechanisms, including an enteropathy and dysmotility. Despite the wider availability of nutrition support teams, use of parenteral nutrition is not without risk. The risks and benefits of parenteral nutrition in the acute setting need to be carefully considered even when it is indicated.

The Role of the Pharmacist in Clinical Settings (6) The Role of the Pharmacist in Nutrition Support Team

The Role of the Pharmacist in Clinical Settings (6) The Role of the Pharmacist in Nutrition Support Team

Elimination of Routine Gastric Residual Volume Monitoring Improves Patient Outcomes in Adult Critically Ill Patients in a Community Hospital Setting.

A community hospital updated its nutrition support practices in 2016 through the elimination of monitoring gastric residual volume (GRV) in accordance with the 2016 Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient: Society of Critical Care Medicine and American Society for Parenteral and Enteral Nutrition. This retrospective analysis (N=61) compared incidence of feeding intolerance in 2 cohorts of adult critically ill patients pre-implementation (n=36) and post-implementation (n=25) of these guidelines into a nutrition support team's standard of practice policy. Differences in kilocalories and protein (gm) received and percent of daily prescribed kilocalories and protein received were also compared between the 2 cohorts. Mean episodes of gastrointestinal intolerance over the number of eligible days of receiving enteral nutrition in the critical care unit did not differ between the pre-implementation and post-implementation groups (P= 0.46). Compared with the pre-implementation group, the post-guideline implementation cohort was significantly more likely to meet higher percentages of both prescribed protein (71.8±22.2% vs 55.9±24.0%; P= 0.01) and energy requirements (93.4±36.9% vs 69.6±35.3%; P= 0.01), even after adjusting for potential confounders (age, body mass index, sex, and primary comorbid medical condition). Elimination of routine monitoring of GRV may result in a greater percentage of prescribed daily nutrient requirements met by patients in the critical care setting, without adverse effects on feeding intolerance.

The Role of a Nutrition Support Team in the Management of Intestinal Failure Patients.

Parenteral nutrition (PN) is a complex and specialized form of nutrition support that has revolutionized the care for both pediatric and adult patients with acute and chronic intestinal failure (IF). This has led to the development of multidisciplinary teams focused on the management of patients receiving PN: nutrition support teams (NSTs). In this review we aim to discuss the historical aspects of IF management and NST development, and the practice, composition, and effectiveness of multidisciplinary care by NSTs in patients with IF. We also discuss the experience of two IF centers as an example of contemporary NSTs at work. An NST usually consists of at least a physician, nurse, dietitian, and pharmacist. Multidisciplinary care by an NST leads to fewer complications including infection and electrolyte disturbances, and better survival for patients receiving short- and long-term PN. Furthermore, it leads to a decrease in inappropriate prescriptions of short-term PN leading to significant cost reduction. Complex care for patients receiving PN necessitates close collaboration between team members and NSTs from other centers to optimize safety and effectiveness of PN use.

Nutritional support practices among intensive care units in Turkey: One-day cross-sectional study

Objective: Malnutrition is a significant problem among critically ill patients and is closely associated with poorer patient outcomes. With this study, we aimed to assess nutritional support practices and to evaluate the associated patient outcomes in intensive care units (ICU) in Turkey. Methods: This one-day, cross-sectional study was conducted in November 2015. A total of 1140 patients from 120 ICUs in 46 hospitals across Turkey were included. The general characteristics of the ICUs and patients, clinical data regarding nutritional support, hospitalization courses of the patients, and patient outcomes were recorded. The study questionnaire was prepared by the investigators and was completed by health care professionals from various hospital departments. Results: The mean age of the patients (55.7% were men) was 66.8±18.0 years. The median duration of the ICU stay was 17 days. Enteral tubes were present in 649 patients, of whom 79.4% had nasogastric tubes, 15.3% had percutaneous endoscopic gastrostomy (PEG) tubes, 4% had nasojejunal tubes, and 1.4% had surgical gastrostomy/jejunostomy tubes. 68.1% of ICUs had a nutritional support team. Nutritional support applied included enteral nutrition (44.1%), oral nutrition (25.9%), parenteral nutrition (18.5%), and enteral + parenteral nutrition (11.5%). On the 60th day, the mortality rate was 39.5%. Mortality rates were significantly lower in the oral nutrition group compared with the other groups, and were significantly higher in the parenteral nutrition group compared with the other groups. Conclusion: Our findings confirm the importance of nutritional support teams to provide timely and adequate administration of nutritional support and its association with better patient outcomes. Additionally, better outcomes were obtained with enteral nutrition compared with parenteral nutrition.

Optimization of the provision of total parenteral nutrition to hospitalized patients in our hospital made by nutritional support team

Optimization of the provision of total parenteral nutrition to hospitalized patients in our hospital made by nutritional support team

Current status and future vision of nutrition support team at the neurological hospital

The effect of malnutrition on intractable neurological diseases, including neurodegenerative diseases, is variable. Nutritional status is dependent on various factors such as disease characteristics; various symptoms including dysphagia, respiratory dysfunction, motor weakness, muscle rigidity, involuntary movement, and ataxia; and changes in energy metabolism caused by diseases and its stage. Nutritional therapy for patients with intractable neurological diseases requires the provision of tailor-made supports for individual patients based on sharing of knowledge and experience in multidisciplinary members. Evidence on nutritional management in the field of neurology is limited compared to that in the fields of surgery and internal medicine. This article thus aimed to describe the activities of the nutrition support team (NST) at our hospital that is specialized in intractable neurological diseases and the knowledge obtained through the activities.