1
|
Jukic Peladic N, Orlandoni P. Development of Quality Indicators for Geriatric Home Enteral Nutrition (HEN) Services. Nutrients 2023; 15:3119. [PMID: 37513537 PMCID: PMC10384251 DOI: 10.3390/nu15143119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 07/05/2023] [Accepted: 07/11/2023] [Indexed: 07/30/2023] Open
Abstract
The evidence on the safety, efficacy and patient centeredness of Home Enteral Nutrition (HEN) services is scarce. In 2015, we carried out a search of the literature to identify specific indicators for HEN services as tools to be used to assess the quality of INRCA HEN services. No specific indicators for HEN services were found. Through a subsequent search of the literature, we have identified the appropriate methodology to define quality indicators and developed eight (8) specific indicators to track the quality of our HEN service for geriatric patients. Following Donabiedan's classification, we have defined two structure indicators, two process indicators and four outcome indicators that are presented in this manuscript. Though they may be used to make a comparison of HEN services for geriatric patients and to monitor the quality of therapy provided at patients' homes, the definition of quality system indicators for HEN services requires the additional joint efforts of experts in the field of nutrition and the scientific community for their validation.
Collapse
Affiliation(s)
- Nikolina Jukic Peladic
- Vivisol Srl., Clinical Nutrition Unit, National Institute of Health and Science on Aging, IRCCS INRCA Ancona, Via della Montagnola 81, 60127 Ancona, Italy
| | - Paolo Orlandoni
- Clinical Nutrition Unit, National Institute of Health and Science on Aging, IRCCS INRCA Ancona, Via della Montagnola 81, 60127 Ancona, Italy
| |
Collapse
|
2
|
The North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition Position on the Role of the Registered Dietitian Nutritionist in the Care of the Pediatric Patient With Chronic Gastrointestinal Diseases. J Pediatr Gastroenterol Nutr 2023; 76:390-399. [PMID: 36580920 DOI: 10.1097/mpg.0000000000003695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The optimization of nutrition is essential for the growth and development of all children, including those with gastrointestinal (GI) conditions that can variably affect nutrient intake, absorption, or metabolism. Registered Dietitian Nutritionists (RDNs) are essential partners in delivering high quality care for pediatric GI disorders, but limited evidence is available to support the role of the RDN in the care of these patients. This position paper outlines the evidence supporting the role of the RDN in the management of chronic pediatric GI issues in both inpatient and outpatient settings. Gaps in the literature, opportunities for future research, and barriers to RDN access are discussed.
Collapse
|
3
|
Dadich A, Hockey K, Kaplun C, Fleming C, Hopwood N, Moraby K, Elliot C. Clinician and carer moral concerns when caring for children who tube-feed. J Child Health Care 2021:13674935211052842. [PMID: 34696607 DOI: 10.1177/13674935211052842] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Child healthcare can be vexed by moral concerns - this extends to the care of children who tube-feed. Children who tube-feed often receive care from family members and clinicians of various disciplines. Each brings expertise, experiences, values, and views to a situation, prioritising the child's needs while attending to those they deem important in potentially disparate ways. Their understanding of a situation is shaped by beliefs, feelings, and perceptions. How then are key decisions made about the care of a child who tube-feeds? This article explores clinicians' and carers' moral concerns when caring for children who tube-feed. Interviews with clinicians (n = 9) and carers (n = 9) clarified three findings: first, there are often disparate beliefs about the need for tube-feeding; second, tube-feeding can evoke strong emotions; and third, it can be difficult to normalise tube-feeding. This article demonstrates how challenges can emerge when relationships between clinicians and carers diverge. Furthermore, it establishes how an ethic of care can bring different interests together to bolster the relationships required to optimise feeding care and promote health outcomes among children who tube-feed and their carers. This requires improved dialogue between and among clinicians and carers to create shared understandings of what is, what should be, and how to benefit children who tube-feed.
Collapse
Affiliation(s)
- Ann Dadich
- School of Business, 6489Western Sydney University, Penrith South, NSW, Australia
| | - Kaitlyn Hockey
- School of Business, 6489Western Sydney University, Penrith South, NSW, Australia
| | - Cathy Kaplun
- School of Nursing and Midwifery, 6489Western Sydney University, Penrith South, NSW, Australia
| | - Catharine Fleming
- School of Science and Health, 6489Western Sydney University, Penrith South, NSW, Australia
| | - Nick Hopwood
- Faculty of Arts and Social Science, 1994University of Technology Sydney, Sydney, NSW, Australia
| | - Khadeejah Moraby
- SA Health, 1050Central Early Childhood and Families Service, Women's and Children's Health Network, Adelaide, SA, Australia
| | - Chris Elliot
- Department of Paediatrics, 90135Saint George Private Hospital, Kogarah, NSW, Australia
| |
Collapse
|
4
|
Flood C, Parker EK, Kaul N, Deftereos I, Breik L, Asrani V, Talbot P, Burgell R, Nyulasi I. A benchmarking study of home enteral nutrition services. Clin Nutr ESPEN 2021; 44:387-396. [PMID: 34330495 DOI: 10.1016/j.clnesp.2021.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 04/16/2021] [Accepted: 05/07/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND & AIMS Patients receiving home enteral nutrition (HEN) via an enteral feeding tube often have complex healthcare requirements. There is limited information regarding how HEN care is provided within Australia and New Zealand. This study aimed to investigate the characteristics of HEN services and the provision of nutrition care to individuals receiving HEN within Australia and New Zealand. METHODS A cross-sectional study, surveying lead HEN dietitians for HEN services was conducted from the period 09 July 2019 to 20 September 2019 inclusive. An online survey was used to obtain data relating to the demographics, funding and clinical resources of respondents' HEN services. Services were benchmarked against a HEN service implementation checklist adapted from the Agency for Clinical Innovation (ACI). RESULTS Responses were received from 107 HEN services, with an estimated combined population of 7122 HEN patients. Services were predominantly government-funded (n = 102, 95.3%) and operated from acute hospitals (n = 57, 53.3%). The reported combined cost of all HEN equipment to the patient ranged from $0-$77 per week or $0-$341 per month. Fifty-two services were reported to have a dedicated HEN dietitian/coordinator, which was positively associated with the undertaking of quality improvement activities (p = 0.019). Mean compliance to the ACI HEN implementation checklist was 70.4% (±15.7%) with a range of 13.0-98.2%. Mean compliance was significantly higher in services with a HEN dietitian/coordinator than services without one (75.5% (±12.0%) vs 64.3% (±16.6%); p < 0.001). CONCLUSIONS This study provides detailed information regarding the characteristics of HEN services and nutrition care provided to enterally-fed patients across Australia and New Zealand. The majority of HEN services are not adhering to the ACI HEN service guidelines and there is considerable variation in cost burden for consumers indicating inequitable delivery of care to patients.
Collapse
Affiliation(s)
- Caroline Flood
- Nutrition Department, Alfred Health, Melbourne, Victoria, Australia.
| | - Elizabeth Kumiko Parker
- Department of Dietetics and Nutrition, Westmead Hospital, Sydney, New South Wales, Australia
| | - Neha Kaul
- Nutrition Department, Alfred Health, Melbourne, Victoria, Australia; Department of Neurosciences, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Irene Deftereos
- Department of Surgery, Western Health, The University of Melbourne, Melbourne, Australia; Department of Nutrition and Dietetics, Western Health, Footscray, Melbourne, Australia
| | - Lina Breik
- Dietetics Department, Eastern Health, Melbourne, Victoria, Australia
| | - Varsha Asrani
- Department of Nutrition and Dietetics, Auckland City Hospital, New Zealand; Surgical and Translational Research (StaR) Centre, School of Medicine, University of Auckland, Auckland, New Zealand
| | - Peter Talbot
- Department of Dietetics and Nutrition, Westmead Hospital, Sydney, New South Wales, Australia
| | - Rebecca Burgell
- Department of Gastroenterology and Department of Hepatology, Alfred Health, Melbourne, Victoria, Australia
| | - Ibolya Nyulasi
- Nutrition Department, Alfred Health, Melbourne, Victoria, Australia; Department of Medicine, Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Rehabilitation, Nutrition and Sport, La Trobe University, Bundoora, Victoria, Australia
| |
Collapse
|
5
|
Tapsell LC. Inter-professional, interdisciplinary and inter-sectoral dietetic practice. Nutr Diet 2019; 76:3-5. [PMID: 30734992 DOI: 10.1111/1747-0080.12507] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 11/12/2018] [Indexed: 02/03/2023]
Affiliation(s)
- Linda C Tapsell
- School of Medicine and Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
| |
Collapse
|