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Gut instinct: Navigating the landscape of parenteral support in short bowel syndrome. 肠道直觉:短肠综合征肠外支持的导航。
IF 2.1 4区 医学 Q3 NUTRITION & DIETETICS Pub Date : 2024-10-01 Epub Date: 2024-05-08 DOI: 10.1002/ncp.11157
Jamie Bering, Sherry Tarleton, John K DiBaise

Depending on the remaining bowel anatomy and the degree of bowel adaptation, patients with short bowel syndrome (SBS) may require parenteral nutrition (PN) and/or intravenous fluid support, sometimes temporarily and sometimes permanently. Although the use of parenteral support in SBS is often lifesaving, it is not without its limitations. Herein, we undertake a focused review of several issues related to use of parenteral support in patients with SBS, including initiation of parenteral support, considerations when formulating PN, select complications, short-term and long-term nutrition monitoring, and weaning strategies.

根据剩余肠道解剖结构和肠道适应程度,短肠综合征(SBS)患者可能需要肠外营养(PN)和/或静脉输液支持,有时是暂时性的,有时是永久性的。虽然肠外支持在 SBS 患者中的应用常常能挽救生命,但它也并非没有局限性。在此,我们将重点回顾与 SBS 患者使用肠外支持相关的几个问题,包括肠外支持的启动、配制 PN 时的注意事项、选择性并发症、短期和长期营养监测以及断奶策略。
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引用次数: 0
Validating the use of body mass index with computed tomography in a racially and ethnically diverse cohort of patients admitted with SARS-CoV-2. 在不同种族和族裔的 SARS-CoV-2 入院患者中验证体质指数与计算机断层扫描的应用。
IF 2.1 4区 医学 Q3 NUTRITION & DIETETICS Pub Date : 2024-10-01 Epub Date: 2024-06-15 DOI: 10.1002/ncp.11164
Patricia Sheean, Paula O'Connor, Cara Joyce, Amy Wozniak, Vasilios Vasilopoulos A, Jared Seigal, Perry Formanek

Background: Body mass index (BMI) is criticized for being unjust and biased in relatively healthy racial and ethnic groups. Therefore, the current analysis examines if BMI predicts body composition, specifically adiposity, in a racially and ethnically diverse acutely ill patient population.

Methods: Patients admitted with SARS-CoV-2 having an evaluable diagnostic chest, abdomen, and/or pelvic computed tomography (CT) study (within 5 days of admission) were included in this retrospective cohort. Cross-sectional areas (centimeters squared) of the subcutaneous adipose tissue (SAT), visceral adipose tissue (VAT), and intramuscular adipose tissue (IMAT) were quantified. Total adipose tissue (TAT) was calculated as sum of these areas. Admission height and weight were applied to calculate BMI, and self-reported race and ethnicity were used for classification. General linear regression models were conducted to estimate correlations and assess differences between groups.

Results: On average, patients (n = 134) were aged 58.2 (SD = 19.1) years, 60% male, and racially and ethnically diverse (33% non-Hispanic White [NHW], 33% non-Hispanic Black [NHB], 34% Hispanic). Correlations between BMI and SAT and BMI and TAT were strongest revealing estimates of 0.707 (0.585, 0.829) and 0.633 (0.534, 0.792), respectively. When examining the various adiposity compartments across race and ethnicity, correlations were similar and significant differences were not detected for TAT with SAT, VAT, or IMAT (all P ≥ 0.05).

Conclusions: These findings support the routine use of applying BMI as a proxy measure of total adiposity for acutely ill patients identifying as NHW, NHB, and Hispanic. Our results inform the validity and utility of this tool in clinical nutrition practice.

背景:身体质量指数(BMI)在相对健康的种族和民族群体中被批评为不公正和有偏见。因此,本次分析研究了 BMI 是否能预测不同种族和民族的急性病患者的身体成分,特别是脂肪含量:方法:本回顾性队列纳入了入院 5 天内进行过胸部、腹部和/或盆腔计算机断层扫描(CT)诊断评估的 SARS-CoV-2 患者。对皮下脂肪组织(SAT)、内脏脂肪组织(VAT)和肌肉内脂肪组织(IMAT)的横截面积(厘米平方)进行了量化。脂肪组织总量(TAT)按这些面积的总和计算。入院时的身高和体重用于计算体重指数,自我报告的种族和民族用于分类。采用一般线性回归模型估算相关性并评估组间差异:患者(n = 134)的平均年龄为 58.2(SD = 19.1)岁,60% 为男性,种族和民族多样化(33% 为非西班牙裔白人 [NHW],33% 为非西班牙裔黑人 [NHB],34% 为西班牙裔)。BMI 与 SAT 和 BMI 与 TAT 之间的相关性最强,估计值分别为 0.707 (0.585, 0.829) 和 0.633 (0.534, 0.792)。在研究不同种族和族裔的各种脂肪含量时,相关性相似,TAT 与 SAT、VAT 或 IMAT 之间未发现显著差异(所有 P 均≥0.05):这些研究结果支持将体重指数(BMI)作为急性病患者(NHW、NHB 和西班牙裔)总脂肪量的常规替代测量方法。我们的研究结果为该工具在临床营养实践中的有效性和实用性提供了参考。
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引用次数: 0
Sleep and home parenteral nutrition in adults: A narrative review. 成人睡眠与家庭肠外营养:叙述性综述。
IF 2.1 4区 医学 Q3 NUTRITION & DIETETICS Pub Date : 2024-10-01 Epub Date: 2024-06-27 DOI: 10.1002/ncp.11181
Hassan S Dashti

Infusions of home parenteral nutrition (HPN) are often cycled at night coinciding with sleep episodes. Adult consumers of HPN are known to experience poor sleep attributed to frequent awakenings and long durations of wakefulness after falling asleep. Consequently, most consumers do not meet recommendations for sleep duration and quality or daytime napping. The primary underlying pathophysiology resulting in sleep problems is nocturia; however, other factors also exist, including disruptions caused by medical equipment (ie, pump alarms), comorbid conditions, dysglycemia, and medication use. Early guidance on sleep is imperative because of the central role of sleep in physical health and wellbeing, including mitigating complications, such as infection risk, gastrointestinal problems, pain sensitivity, and fatigue. Clinicians should routinely inquire about the sleep of their patients and address factors known to perturb sleep. Nonpharmacologic opportunities to mitigate sleep problems include education on healthy sleep practices (ie, sleep hygiene); changes in infusion schedules, volumes, rates, and equipment; and, possibly, behavioral interventions, which have yet to be examined in this population. Addressing comorbid conditions, such as mood disorders, and nutrition deficiencies may also help. Pharmacologic interventions and technological advancement in HPN delivery are also needed. Research on sleep in this population is considered a priority, yet it remains limited at this time.

家用肠外营养液(HPN)的输注通常在夜间睡眠时进行。众所周知,使用 HPN 的成人会因频繁觉醒和入睡后长时间清醒而睡眠不佳。因此,大多数消费者的睡眠时间和质量或白天小睡时间都不符合建议。夜尿症是导致睡眠问题的主要潜在病理生理学因素,但也存在其他因素,包括医疗设备(即泵报警器)、合并症、血糖异常和药物使用造成的干扰。由于睡眠在身体健康和福祉方面发挥着核心作用,包括减少感染风险、胃肠道问题、疼痛敏感性和疲劳等并发症,因此必须及早提供睡眠指导。临床医生应定期询问患者的睡眠情况,并解决已知的干扰睡眠的因素。缓解睡眠问题的非药物治疗方法包括健康睡眠方法教育(即睡眠卫生);改变输液时间、输液量、输液速度和输液设备;以及可能的行为干预,但这些方法在此类人群中尚有待研究。解决合并症(如情绪障碍和营养缺乏)也可能有所帮助。此外,还需要药物干预和 HPN 输送技术的进步。对这一人群的睡眠研究被认为是当务之急,但目前仍很有限。
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引用次数: 0
Use of technology in neonatal nutrition. 在新生儿营养中使用技术。
IF 2.1 4区 医学 Q3 NUTRITION & DIETETICS Pub Date : 2024-10-01 Epub Date: 2024-06-17 DOI: 10.1002/ncp.11176
Cristina Miller, Erin Plummer, Jenna Platek, Steffi Arneson

There have been rapidly expanding uses of technology to enhance and improve nutrition in our smallest patients. Optimized nutrition in the neonatal patient is linked to improved outcomes, specifically neurodevelopmental outcomes and decreased length of stay. Despite advances in neonatal care that have improved survival, many patients being discharged from the neonatal intensive care unit are doing so with poor postnatal growth. Because the neonatal brain doubles in size from 20 weeks gestation to term, it is essential to focus care efforts on nutrition to optimize brain growth and development. This review focuses on three exciting areas of neonatal research, including the analysis of macronutrients in breast milk, measurement of body composition, and use of telemedicine.

在加强和改善最小病人的营养方面,技术的应用正在迅速扩大。优化新生儿患者的营养与改善预后有关,特别是神经发育预后和缩短住院时间。尽管新生儿护理方面的进步提高了存活率,但许多从新生儿重症监护室出院的患者产后生长状况不佳。由于从妊娠 20 周到足月,新生儿大脑的大小会增加一倍,因此必须将护理工作的重点放在营养上,以优化大脑的生长和发育。本综述重点关注新生儿研究的三个令人兴奋的领域,包括母乳中宏量营养素的分析、身体成分的测量和远程医疗的使用。
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引用次数: 0
The lingering safety menace: A 10-year review of enteral misconnection adverse events and narrative review. 挥之不去的安全威胁:肠道错接不良事件 10 年回顾和叙述性回顾。
IF 2.1 4区 医学 Q3 NUTRITION & DIETETICS Pub Date : 2024-10-01 Epub Date: 2024-07-18 DOI: 10.1002/ncp.11191
Stacie Ethington, Amanda Volpe, Peggi Guenter, Debora Simmons

In 2011, "Tubing Misconnections: Normalization of Deviance" reported >100 cases of enteral tubing misconnections leading to patient harm. Despite development of safer enteral device connectors, 96 new cases of enteral misconnections have been published since 2011. Publication and safety databases were searched for reports from 2011 to 2023. Reported misconnections lead to death in 4% of the cases and survival with harm were reported in 69% of cases. Reported misconnections occurred more often in infants and children than in adults. This article outlines why these misconnections happen, the history of the issue and development of safer connector standards, the safety threats and recommendations associated with the new cases, current conversion rates, and process steps, education, and resources for the conversion to safer connectors for enteral nutrition devices.

2011 年,"管道错接:偏差的正常化 "报告了超过 100 例导致患者受伤的肠管错接案例。尽管开发出了更安全的肠道器械连接器,但自 2011 年以来,又发表了 96 例新的肠道错接病例。我们在出版物和安全数据库中搜索了 2011 年至 2023 年的报告。报告的误连接导致死亡的病例占 4%,存活并造成伤害的病例占 69%。与成人相比,报告的误连接更多发生在婴儿和儿童身上。本文概述了发生这些错接的原因、该问题的历史和更安全连接器标准的发展、与新病例相关的安全威胁和建议、当前的转换率,以及肠内营养设备转换为更安全连接器的流程步骤、教育和资源。
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引用次数: 0
Micronutrient supplementation in patients with malabsorptive conditions. 吸收不良患者的微量营养素补充。
IF 2.1 4区 医学 Q3 NUTRITION & DIETETICS Pub Date : 2024-10-01 Epub Date: 2024-07-14 DOI: 10.1002/ncp.11190
Gabriela Gardner

Patients with malabsorptive conditions can develop micronutrient deficiencies, even if they receive vitamins, minerals, or trace elements through their enteral or parenteral nutrition. Additionally, clinicians have faced challenges with micronutrient supplementation during parenteral product shortages and when transitioning patients from parenteral to enteral/oral nutrition. Evaluating micronutrient deficiencies through laboratory markers has various limitations, including that many are acute phase reactants, may not reflect storage status, or may not be readily available in clinical practice. Furthermore, clinicians can become overwhelmed with the variety of vitamin and mineral products available, the differences in dosages and ingredients in these products, and lastly, the inherent challenges associated with an impaired gastrointestinal tract. The current review will discuss some challenges clinicians may encounter in clinical practice during the evaluation, assessment, and prescription of micronutrient supplementation in patients with malabsorptive conditions.

吸收不良的患者即使通过肠内或肠外营养获得维生素、矿物质或微量元素,也会出现微量营养素缺乏症。此外,临床医生在肠外营养品短缺时以及病人从肠外营养过渡到肠内/口服营养时,也面临着微量营养素补充的挑战。通过实验室指标来评估微量营养素缺乏症有各种局限性,包括许多指标是急性期反应物,可能无法反映储存状态,或者在临床实践中可能无法随时获得。此外,临床医生可能会因为维生素和矿物质产品种类繁多、这些产品的剂量和成分各不相同而不知所措,最后,胃肠道受损也会带来固有的挑战。本综述将讨论临床医生在临床实践中对吸收不良患者进行微量营养素补充的评估、评价和处方时可能遇到的一些挑战。
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引用次数: 0
Role of the neonatal registered dietitian nutritionist in Canada: A description of staffing and a comparison to practices in the United States. 加拿大新生儿注册营养师的作用:人员配备说明及与美国做法的比较。
IF 2.1 4区 医学 Q3 NUTRITION & DIETETICS Pub Date : 2024-10-01 Epub Date: 2024-07-15 DOI: 10.1002/ncp.11182
Stephanie Merlino Barr, Rosa K Hand, Tanis R Fenton, Sharon Groh-Wargo

Background: Neonatal registered dietitian nutritionists (RDNs) are critical members of the neonatal intensive care unit (NICU) team. Ideal RDN staffing levels are unknown. Current staffing levels of neonatal RDNs in Canadian NICUs have not been recently reported. The objective of this study was to describe neonatal RDN staffing and responsibilities in Canada and contrast these findings with those of neonatal RDNs in the United States.

Methods: An online cross-sectional neonatal RDN survey was performed in the Fall of 2021 to collect hospital-level and individual-RDN-level data. Descriptive statistics were performed to summarize Canadian neonatal RDN staffing levels and responsibilities and compared with US findings.

Results: Canadian RDNs reported a median staffing ratio of 25.3 NICU beds per RDN full-time equivalent, with neonatal RDNs reporting a desired 31% increase in staffing. The majority of Canadian NICUs (n = 20/24) reported having a dedicated space to prepare infant feeds away from bedside. Canadian neonatal RDNs reported wanting to expand their responsibilities in research, administration, and education. Canadian neonatal RDNs reported a higher rate of order writing privileges as compared with that of US neonatal RDNs.

Conclusion: Canadian neonatal RDNs reported a desired increase in their staffing levels. Neonatal RDNs have the potential to expand their professional role but require additional staffing, dedicated time, and compensation to support this. Further research determining the optimal neonatal RDN staffing ratio to maximize patient outcomes is required.

背景:新生儿注册营养师(RDN)是新生儿重症监护室(NICU)团队的重要成员。理想的 RDN 人员配备水平尚不清楚。加拿大新生儿重症监护病房目前的新生儿注册营养师人员配备水平最近尚未见报道。本研究旨在描述加拿大新生儿研发护士的人员配备和职责,并将这些结果与美国新生儿研发护士的人员配备和职责进行对比:方法: 2021 年秋季进行了一项在线横断面新生儿康复护士调查,以收集医院层面和康复护士个人层面的数据。通过描述性统计总结了加拿大新生儿康复师的人员配备水平和职责,并与美国的调查结果进行了比较:结果:加拿大新生儿康复师报告的人员配备比中位数为每名相当于全职康复师的新生儿重症监护病房床位数为 25.3 张,新生儿康复师报告希望增加 31% 的人员配备。大多数加拿大新生儿重症监护室(n = 20/24)都报告说有一个远离床边的专用空间来准备婴儿喂养。加拿大新生儿营养师表示希望扩大他们在研究、管理和教育方面的职责。与美国新生儿营养师相比,加拿大新生儿营养师拥有较高的医嘱书写权限:结论:加拿大新生儿研发护士希望增加人员编制。新生儿研发护士有潜力扩展其专业角色,但需要额外的人员配备、专门的时间和报酬来支持。需要进一步研究确定新生儿康复营养师的最佳人员配备比例,以最大限度地提高患者的治疗效果。
{"title":"Role of the neonatal registered dietitian nutritionist in Canada: A description of staffing and a comparison to practices in the United States.","authors":"Stephanie Merlino Barr, Rosa K Hand, Tanis R Fenton, Sharon Groh-Wargo","doi":"10.1002/ncp.11182","DOIUrl":"10.1002/ncp.11182","url":null,"abstract":"<p><strong>Background: </strong>Neonatal registered dietitian nutritionists (RDNs) are critical members of the neonatal intensive care unit (NICU) team. Ideal RDN staffing levels are unknown. Current staffing levels of neonatal RDNs in Canadian NICUs have not been recently reported. The objective of this study was to describe neonatal RDN staffing and responsibilities in Canada and contrast these findings with those of neonatal RDNs in the United States.</p><p><strong>Methods: </strong>An online cross-sectional neonatal RDN survey was performed in the Fall of 2021 to collect hospital-level and individual-RDN-level data. Descriptive statistics were performed to summarize Canadian neonatal RDN staffing levels and responsibilities and compared with US findings.</p><p><strong>Results: </strong>Canadian RDNs reported a median staffing ratio of 25.3 NICU beds per RDN full-time equivalent, with neonatal RDNs reporting a desired 31% increase in staffing. The majority of Canadian NICUs (n = 20/24) reported having a dedicated space to prepare infant feeds away from bedside. Canadian neonatal RDNs reported wanting to expand their responsibilities in research, administration, and education. Canadian neonatal RDNs reported a higher rate of order writing privileges as compared with that of US neonatal RDNs.</p><p><strong>Conclusion: </strong>Canadian neonatal RDNs reported a desired increase in their staffing levels. Neonatal RDNs have the potential to expand their professional role but require additional staffing, dedicated time, and compensation to support this. Further research determining the optimal neonatal RDN staffing ratio to maximize patient outcomes is required.</p>","PeriodicalId":19354,"journal":{"name":"Nutrition in Clinical Practice","volume":" ","pages":"1212-1226"},"PeriodicalIF":2.1,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141620549","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
ASPEN survey of parenteral nutrition access issues: How the system fails the patient. ASPEN 关于肠外营养获取问题的调查:系统如何辜负了患者。
IF 2.1 4区 医学 Q3 NUTRITION & DIETETICS Pub Date : 2024-10-01 Epub Date: 2024-07-18 DOI: 10.1002/ncp.11187
Jay M Mirtallo, Penny Allen, Wendy M Book, Kathryn Hennessy, Bettiemarie Bond, Beth Gore

Background: Product shortages and a lack of qualified providers to manage care may impact the safety and efficacy of parenteral nutrition (PN). This survey assessed the frequency and extent to which limitations to PN-related access affects patients.

Methods: Outpatient/patients receiving home PN were surveyed. Questions were developed to characterize the population and determine the extent and severity of PN access issues with components, devices, healthcare professionals, and transfers of care. Reimbursement issues surveyed included insurance coverage, contribution of healthcare costs to annual income, and the extent to which adjunctive therapy was reimbursed. Burdens surveyed included impact on disease symptoms and medical outcomes as well as the types and frequency of medical or system errors experienced, adverse events, or resultant nutrition problems.

Results: Respondents (N = 170) were well educated, rented or owned their own home, and were either employed or retired. All age populations were represented. Patients made frequent contact with care providers. Most were able to manage PN costs but feared losing insurance or changes to insurance. Patients used additional prescribed therapies that are poorly covered by insurance. Patients reported symptoms or exacerbation of disease, development or worsening of malnutrition, and episodes of nutrient deficiency. Patients noted errors occur, especially during periods of transitions of care, when they also often encounter clinicians with little understanding of PN. These are high-acuity patients who have difficulty finding providers for their care.

Conclusion: This patient survey provides evidence that access issues can result in the "failure of the PN system" to assure care is consistently safe and effective.

背景:产品短缺和缺乏合格的医疗服务提供者来管理护理可能会影响肠外营养(PN)的安全性和有效性。这项调查评估了与肠外营养相关的限制对患者造成影响的频率和程度:方法:对接受居家 PN 的门诊/住院患者进行了调查。我们设计了一些问题来描述人群特征,并确定患者在使用 PN 时遇到的组件、设备、医护人员和护理转移等问题的程度和严重性。调查的报销问题包括保险覆盖范围、医疗费用对年收入的贡献以及辅助治疗的报销范围。调查的负担包括对疾病症状和医疗结果的影响,以及所经历的医疗或系统错误、不良事件或由此导致的营养问题的类型和频率:受访者(N = 170)受过良好教育,租房或拥有自己的住房,有工作或已退休。所有年龄段的人都有。患者经常与医疗服务提供者联系。大多数患者能够控制 PN 费用,但担心失去保险或保险发生变化。患者使用额外的处方疗法,而这些疗法的保险覆盖率很低。患者报告了疾病症状或病情加重、营养不良的发展或恶化以及营养缺乏的情况。患者指出,错误时有发生,尤其是在护理过渡期间,他们还经常遇到对营养补充剂知之甚少的临床医生。这些都是高危患者,他们很难找到为其提供护理的医疗服务提供者:这项患者调查提供了证据,证明就医问题可能导致 PN 系统 "失灵",无法确保护理始终安全有效。
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引用次数: 0
Prevention of complications for hospitalized patients receiving parenteral nutrition: A narrative review. 预防接受肠外营养的住院病人出现并发症:综述。
IF 2.1 4区 医学 Q3 NUTRITION & DIETETICS Pub Date : 2024-10-01 Epub Date: 2024-08-16 DOI: 10.1002/ncp.11201
Dina Al-Zubeidi, Mary Beth Davis, Riad Rahhal

Hospitalized patients may benefit from parenteral nutrition to address their compromised nutrition status attributed to limited oral/enteral intake and increased nutrient/energy requirement during acute illness. Parenteral nutrition, however, can be associated with many complications that can negatively impact patient outcomes. In this review, we focus on potential metabolic and catheter-related complications associated with parenteral nutrition use. We report on potential risk factors for such complications and highlight strategies for prevention and early recognition. To optimize outcomes, key findings include the creation and implementation of evidence-based protocols with proven efficacy. For each hospital unit delivering parenteral nutrition to patients, tracking compliance with established protocols and patient outcomes is crucial for ongoing improvement through identification of gaps, proper reeducation and training, and ongoing refinement of care protocols. Establishment of specialized inpatient nutrition support teams should be considered.

住院病人可能会受益于肠外营养,以解决他们因急性病期间口服/肠道摄入量有限和营养/能量需求增加而导致的营养状况受损问题。然而,肠外营养可能会引起许多并发症,对患者的预后产生负面影响。在本综述中,我们将重点讨论与使用肠外营养相关的潜在代谢并发症和导管相关并发症。我们报告了此类并发症的潜在风险因素,并强调了预防和早期识别的策略。为了优化治疗效果,我们的主要发现包括制定和实施以证据为基础的、经证实有效的治疗方案。对于为患者提供肠外营养的每个医院单位来说,跟踪既定方案的合规性和患者的治疗效果对于通过找出差距、适当的再教育和培训以及不断完善护理方案来持续改进至关重要。应考虑建立专门的住院病人营养支持团队。
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引用次数: 0
Enhancing nutritional formula expiry monitoring: A quality improvement project in a tertiary-level hospital in Riyadh, Saudi Arabia. 加强营养配方奶过期监测:沙特阿拉伯利雅得一家三级医院的质量改进项目。
IF 2.1 4区 医学 Q3 NUTRITION & DIETETICS Pub Date : 2024-10-01 Epub Date: 2024-06-18 DOI: 10.1002/ncp.11172
Sawsan Albalawi, Rania AlObari, Eyad AlMidani, Rafat Malkawi, Dima Abosaleh, Sozan Qarni, Sasikalan Subrayan, Saif Almuteiry, Leodevina Abel-Reyes, Bader Alhazaa, Raghad Alhuthil

Background: Nutrition is a vital part of any treatment plan. This may include providing nutritional formulas during hospitalization and afterward. However, reported incidents showed that we had issues with nutritional formula expiry monitoring at our hospital with low compliance to Joint Commission International Standards (MMU.3.1): "There is a process for storage of medications and nutritional products that require special consideration." Therefore, a "Nutritional Formula Expiry Monitoring" project was created to decrease hospital safety incidents related to expired nutritional formulas from an average of 28 in 2015 to zero by 2018.

Materials and methods: A quality improvement model was developed to map the existing formula processes. Several proposed ideas were tested including performing a hospital-wide audit to examine possible risks and practices, developing a hospital policy, flow charts, forms, and audit tools, and providing educational presentations.

Results: A total of 40 units in the hospital were included in the implementation. After implementing all the change ideas, the system for monitoring the expiry of the nutritional formula was standardized, and the number of reported incidents related to the nutritional formula decreased from 28 in the third quarter of 2015 to one in the first quarter of 2018.

Conclusion: This project provided step-by-step instructions for improving storing, delivering, and monitoring of nutritional formula. Consequently, the incidences of expired formula and cost wasting were successfully decreased, which increased safe administration and prevented patients from receiving expired nutritional formula. This project can be implemented in various healthcare settings.

背景:营养是任何治疗计划的重要组成部分。这可能包括在住院期间和之后提供营养配方。然而,报告的事件表明,我们医院在营养配方有效期监测方面存在问题,对联合委员会国际标准(MMU.3.1)的合规性较低:"有一个需要特别考虑的药品和营养品储存流程"。因此,我们创建了一个 "营养配方食品过期监测 "项目,旨在将与过期营养配方食品相关的医院安全事件从2015年的平均28起减少到2018年的零起:开发了一个质量改进模型,以绘制现有配方流程图。对提出的几个想法进行了测试,包括在全院范围内开展审计以检查可能存在的风险和做法,制定医院政策、流程图、表格和审计工具,以及提供教育讲座:结果:医院共有 40 个单位参与了实施工作。在实施了所有变革思路后,营养配方奶的过期监测系统得到了规范,与营养配方奶相关的上报事故数量从 2015 年第三季度的 28 起减少到 2018 年第一季度的 1 起。结论:该项目提供了循序渐进的指导:该项目为改善营养配方奶粉的储存、交付和监测提供了逐步指导。因此,成功减少了过期配方奶的发生率和成本浪费,提高了安全管理水平,避免了患者收到过期营养配方奶。该项目可在各种医疗机构中实施。
{"title":"Enhancing nutritional formula expiry monitoring: A quality improvement project in a tertiary-level hospital in Riyadh, Saudi Arabia.","authors":"Sawsan Albalawi, Rania AlObari, Eyad AlMidani, Rafat Malkawi, Dima Abosaleh, Sozan Qarni, Sasikalan Subrayan, Saif Almuteiry, Leodevina Abel-Reyes, Bader Alhazaa, Raghad Alhuthil","doi":"10.1002/ncp.11172","DOIUrl":"10.1002/ncp.11172","url":null,"abstract":"<p><strong>Background: </strong>Nutrition is a vital part of any treatment plan. This may include providing nutritional formulas during hospitalization and afterward. However, reported incidents showed that we had issues with nutritional formula expiry monitoring at our hospital with low compliance to Joint Commission International Standards (MMU.3.1): \"There is a process for storage of medications and nutritional products that require special consideration.\" Therefore, a \"Nutritional Formula Expiry Monitoring\" project was created to decrease hospital safety incidents related to expired nutritional formulas from an average of 28 in 2015 to zero by 2018.</p><p><strong>Materials and methods: </strong>A quality improvement model was developed to map the existing formula processes. Several proposed ideas were tested including performing a hospital-wide audit to examine possible risks and practices, developing a hospital policy, flow charts, forms, and audit tools, and providing educational presentations.</p><p><strong>Results: </strong>A total of 40 units in the hospital were included in the implementation. After implementing all the change ideas, the system for monitoring the expiry of the nutritional formula was standardized, and the number of reported incidents related to the nutritional formula decreased from 28 in the third quarter of 2015 to one in the first quarter of 2018.</p><p><strong>Conclusion: </strong>This project provided step-by-step instructions for improving storing, delivering, and monitoring of nutritional formula. Consequently, the incidences of expired formula and cost wasting were successfully decreased, which increased safe administration and prevented patients from receiving expired nutritional formula. This project can be implemented in various healthcare settings.</p>","PeriodicalId":19354,"journal":{"name":"Nutrition in Clinical Practice","volume":" ","pages":"1227-1238"},"PeriodicalIF":2.1,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141420094","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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Nutrition in Clinical Practice
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