Speaking the same language: Development of a Nutrition Minimum Data Set for healthcare professionals in primary healthcare

Determining the minimum data elements to develop a child malnutrition registry system

BACKGROUND

Today, malnutrition is one of the biggest health crises for children in the world. Access to accurate and high-quality data is very important to establish policies to deal with it. Registries are considered valuable tools for data collection and management of child malnutrition. Designing a dataset is the first step toward developing a registry system.

OBJECTIVE

This study aimed to determine the minimum data elements for the Child Malnutrition Registry System (CMRS).

METHODS

In this descriptive and cross-sectional study, firstly, data elements were extracted from reviewing scientific papers, reviewing existing systems, and conducting interviews with experts. Then, the extracted data elements were validated using an expert panel and Delphi technique. The criterion for accepting the final data elements in the registry system was based on a collective agreement, and it was when 75% of the experts collectively agreed upon a particular data element.

RESULTS

A dataset was designed using the determined minimum data elements, including administrative data elements with three sub-categories (demographic, socioeconomic, and healthcare providers) and clinical data elements with 11 sub-categories (medical history, anthropometric indicators, clinical examination, nutritional data, physical activity and sleep, lab tests, para-clinical tests, diagnosis, complications, care procedures, life status, and follow-up). The number of final data elements in administrative and clinical categories were 47 and 251, respectively.

CONCLUSION

A comprehensive and accurate dataset provides conceptual structures that are the basis for developing the children's malnutrition registry system. The result of this study can fill the existing gaps in collecting, storing, and analyzing child malnutrition data. Furthermore, it can play an effective role in creating a successful strategic plan for improving child malnutrition.

Individual and contextual factors in the Swedish Nutrition Care Process Terminology implementation

BACKGROUND

Standardised terminologies and classification systems play an increasingly important role in the continuous work towards high quality patient care. Currently, a standardised terminology for nutrition care, the Nutrition Care Process (NCP) Terminology (NCPT), is being implemented across the world, with terms for four steps: Nutrition Assessment (NA), Nutrition Diagnosis (ND), Nutrition Intervention (NI) and Nutrition Monitoring and Evaluation (NME).

OBJECTIVE

To explore associations between individual and contextual factors and implementation of a standardised NCPT among Swedish dietitians.

METHOD

A survey was completed by 226 dietitians, focussing on: (a) NCPT implementation level; (b) individual factors; and (c) contextual factors. Associations between these factors were explored through a two-block logistic regression analysis.

RESULTS

Contextual factors such as intention from management to implement the NCPT (OR (odds ratio) ND 15.0, 95% Confidence Interval (CI) 3.9-57.4, NME 3.7, 95% CI 1.1-13.0) and electronic health record (EHR) headings from the NCPT (OR NI 3.6, 95% CI 1.4-10.7, NME 3.8, 95% CI 1.1-11.5) were associated with higher implementation. A positive attitude towards the NCPT (model 1 OR ND 3.8, 95% CI 1.5-9.8, model 2 OR ND 5.0, 95% CI 1.4-17.8) was also associated with higher implementation, while other individual factors showed less association.

CONCLUSION

Contextual factors such as intention from management, EHR structure, and pre-defined terms and headings are key to implementation of a standardised terminology for nutrition and dietetic care.

IMPLICATIONS FOR PRACTICE

Clinical leadership and technological solutions should be considered key areas in future NCPT implementation strategies.

Performance of tunnelled, non-cuffed central venous catheters in infants: A scoping review

AIM

To summarise and critique existing knowledge and evidence relating to the utility, and post-insertion complications surrounding tunnelled non-cuffed central venous catheters (tncCVCs) in infants.

METHODS

A scoping review of original research studies reporting the use of, and post-insertion complications associated with, tncCVCs in infants was completed. MeSH terms were used to formulate a systematic search, and data were extracted using a customised data extraction form. Data were analysed descriptively across key themes based on the research questions. Study quality was evaluated using the Mixed Methods Appraisal Tool.

RESULTS

The systematic search generated 3994 studies, of which 9 studies met final inclusion criteria. Studies included 644 tncCVCs in infants based in the USA, Europe and Australia. Most studies were retrospective cohort studies. The most common vein of insertion, where individually specified, was the internal jugular (n = 177). Tunnel length, where reported, was 2.5-5 cm. Infection rates were most commonly reported (eight studies), with results ranging from 0 to 12.8%, and device dislodgements of up to 20% reported. Participant follow-up and definition of complications varied greatly between studies. Study quality across all papers was sound.

CONCLUSIONS

This review has identified only a small number of studies, with small participant numbers, reporting the performance of tncCVCs in infants. Definitions of complications measured varied significantly between studies, and vastly different patient follow-up protocols were reported. Further larger-scale studies on the performance of tncCVC, employing internationally recognised reporting standards is warranted to ensure clinicians can make informed choices for medication and infusion delivery.

Outcomes collected in female pelvic floor surgical procedure registries and databases: a scoping review

INTRODUCTION AND HYPOTHESIS

The objective was to overview the literature on the existing pelvic floor procedure registries and databases and to identify patient demographic, clinical and/or patient-reported data items for inclusion in the Australasian Pelvic Floor Procedure Registry (APFPR) Minimum Data Set (MDS).

METHODS

We conducted a literature search on the MEDLINE, Embase, CINAHL and PsycINFO databases in addition to Google Scholar and grey literature to identify studies in the period January 2008 to January 2020. All were English studies of registries and databases on female adults undergoing surgery for pelvic floor disorders including stress urinary incontinence (SUI) and pelvic organ prolapse (POP). Studies were assessed on demographic and clinical patient characteristics, procedure or treatment type, health-related quality of life, adverse events and safety outcomes, captured by pelvic floor procedure registries or databases that have been established to date.

RESULTS

From 1662 studies, 29 publications describing 22 different pelvic floor registries and databases were included for analysis, 12 (55%) of which were multicentre. Six (27%) registries and databases involved solely SUI, eight (36%) were regarding POP, and the remaining eight (36%) focussed on both conditions. The majority of registries and databases captured similar details on patient characteristics, comorbidities and other clinical features, procedure or treatment type, health-related quality of life, adverse events, safety and efficacy.

CONCLUSION

The findings of this scoping review will assist in determining the MDS for the APFPR, an initiative of the Australian government, to improve health and quality of life outcomes of women who undergo pelvic floor reconstructive procedures.

Developing a nursing diagnosis for the risk for malnutrition: a mixed-method study

AIM

As the risk for malnutrition in older people in hospitals is often underreported, we aimed to develop a risk nursing diagnosis, including label, definition and risk factors.

DESIGN

A convergent parallel mixed-methods design was employed.

METHODS

A literature review led to risk factors, validated by 22 hospitalized older people's perspectives and observations, including their nursing records. Per participant, one interview (qualitative), one non-participatory observation of three meals (198 hr; qualitative) and one nursing record evaluation (quantitative) were conducted.

FINDINGS

According to the classification system of NANDA International, the risk for protein-energy malnutrition is defined with 18 risk factors, including associated conditions. Content validated risk factors are presented from three participants with the most, medium and least coherent nursing record, measured with the Quality of Diagnosis, Intervention and Outcomes tool.

CONCLUSION

This new nursing diagnosis supports nurses to manage the risk for malnutrition and optimize older people's nutrition.

Minimum data set development for a drug poisoning registry system

Objective

Drug poisoning is the most prevalent type of poisoning throughout the world that can occur intentional or unintentional. Standard way for data gathering with uniform definitions is a requirement for preventing, controlling and managing of drug poisoning management. The purpose of this study was to develop a minimum data set, as an initial step, for a drug poisoning registry system in Iran.

Methods

This was descriptive and cross-sectional study that was performed in 2019. As the first step a comprehensive literature review was performed to retrieve related resources in Persian and English languages. For the second step the medical records of drug poisoning patients at Afzalipour hospital affiliated to Kerman University of Medical Sciences were assessed. Related data from these two steps were gathered by a checklist. Finally, a questionnaire that was created based on the checklist data elements and had three columns of ‘essential,' ‘useful, but not essential', and ‘not essential' was used to reach a consensus on the data elements. Then the content validity ratio and the mean of experts’ judgments were calculated for each data element. The Cronbach’s alpha value for the entire questionnaire was obtained 0.9.

Results

The minimum data set of a drug poisoning registry system was categorised into the administrative part with three sections including 32 data elements, and clinical parts with six sections including 81 data elements.

Conclusion

This study provides a minimum data set for development of a drug poisoning registry system. Collecting this minimum data set is critical for helping policy makers and healthcare providers to prevent, control and manage drug poisoning.

Lack of focus on nutrition and documentation in nursing homes, home care- and home nursing: the self-perceived views of the primary care workforce

Background

Malnutrition is a comprehensive challenge for the nursing home, home care- and home nursing sector. Nutritional care and the subsequent documentation are a common and multifaceted healthcare practice that requires that the healthcare professionals possess complex combinations of competencies in order to deliver high-quality care and treatment. The purpose of this study was to investigate how a varied group of healthcare professionals’ perceive their own competencies within nutrition and documentation and how organizational structures influence their daily work and the quality of care provided.

Methods

Two focus groups consisting of 14 healthcare professionals were conducted. The transcribed focus group interviews was analyzed using the qualitative content analysis approach.

Results

Six categories were identified: 1) Lack of uniform and systematic communication affect nutritional care practices 2) Experience-based knowledge among the primary workforce influences daily clinical decisions, 3) Different attitudes towards nutritional care lead to differences in the quality of care 4) Differences in organizational culture affect quality of care, 5) Lack of clear nutritional care responsibilities affect how daily care is performed and 6) Lack of clinical leadership and priorities makes nutritional care invisible.

Conclusions

The six categories revealed two explanatory themes: 1) Absent inter- and intra-professional collaboration and communication obstructs optimal clinical decision-making and 2) quality deterioration due to poorly-established nutritional care structure. Overall, the two themes explain that from the healthcare professionals’ point of view, a visible organization that allocates resources as well as prioritizing and articulating the need for daily nutritional care and documentation is a prerequisite for high-quality care and treatment. Furthermore, optimal clinical decision making among the healthcare professionals are compromised by imprecise and unclear language and terminology in the patients’ healthcare records and also a lack of clinical guidelines and standards for collaboration between different healthcare professionals working in nursing homes, home care or home nursing.

The findings of this study are beneficial to support organizations within these settings with strategies focusing on increasing nutritional care and documentation competencies among the healthcare professionals. Furthermore, the results advocate for the daily involvement and support of leaders and managers in articulating and structuring the importance of nutritional care and treatment and the subsequent documentation.

Electronic supplementary material

The online version of this article (10.1186/s12913-019-4450-1) contains supplementary material, which is available to authorized users.