Every hospital trust should establish a Nutrition Support Team (NST), composed of doctors with an interest in nutritional support, specialist nurses, dietitians and pharmacists.
Monitoring people receiving nutrition support is of great importance. This includes hospital inpatients as well as outpatients at high risk of malnutrition.
What is it?
Many health conditions make it challenging to maintain a regular diet and weight, leading them to take steps like oral and nutritional supplements in order to achieve this. Others require tube feeding as the only means of receiving enough energy from food sources – this form of nutrition support is known.
Nutritious elements can be administered in various ways – either directly into the stomach and small intestine via enteral tube feeding, or directly into the bloodstream through parenteral nutrition (PN). Each person can choose their tube type, nutritional mix and caloric content accordingly.
Hospital trusts should create a specialist team to oversee tube feeding for nutritional support to ensure its safetiness, including a clinical nurse specialist, dietitian and pharmacist working under the guidance of a nutrition steering committee. The team may monitor laboratory values based on clinical needs such as glucose assessment for good glycaemic control.
How is it done?
Hospital patients requiring nutrition support can have their meals administered either through an artificial tube (feeding tube) or directly via IV (PN). Either way, healthcare professionals with appropriate skills and knowledge should closely supervise these individuals to ensure optimal care is received.
An effective nutrition support team in hospital should include at least a physician, nurse specialist and dietitian, working under the guidance of a nutrition steering committee. Their primary responsibilities should include accurate weighing and measuring, prescribing of appropriate formulas for patients using parenteral nutrition (PN) treatments as well as monitoring fluid balance for those receiving PN as well as providing advice about catheter care to minimise complications like sepsis or thrombosis.
As soon as nutrition support begins, it should be implemented at no more than 50% of estimated target energy and protein needs and gradually increased as tolerated. Healthcare professionals should periodically assess its indications, route, risks and benefits in order to make any adjustments as necessary.
What are the risks?
Malnutrition is a significant risk factor for adverse hospitalized patient outcomes, such as increased morbidity and mortality rates, longer hospital stays, and higher health care costs. Early recognition of nutritional risk and implementation of tailored nutrition support regimens may mitigate such negative clinical outcomes.
No matter the route used, nutritional support may increase short-term follow up weight among adults at nutritional risk; however, evidence is scarce as to its ability to decrease mortality rates.
A multidisciplinary team consisting of physicians, nutrition nurse specialists, registered dietitians and pharmacists should assess EN/PN needs and prescribe appropriately. The team should also identify malnutrition during treatment and track its progression during this phase as well as include patient nutritional/fluid status in their clinical notes. Healthcare professionals differed greatly in terms of confidence with providing nutrition support; higher degrees of qualification or experience was typically linked with greater levels of comfort with providing nutritional assistance.
What are the benefits?
Nutritional support for those unable to consume or absorb nutrients through their digestive systems is invaluable in maintaining weight, increasing energy levels and enhancing quality of life – as well as alleviating worry over not being able to eat.
Nutrition support is often provided through artificial feeding tubes (artificial feeding). These feeding tubes can go directly into the stomach or bowel or vein and contain carbohydrates, proteins, fats and vitamins and minerals tailored specifically to an individual’s estimated energy needs and adjusted based on factors like age, sex and activity level.
People requiring long-term nutritional support must be carefully monitored on an ongoing basis, to assess both fluid balance and sodium balance (which is especially vital in patients who rely on small bowel or fistula output). A monitor capable of calculating daily weight, total body water (TBW), 24-hour urine sodium concentration levels, recording results from blood tests for sugar and calcium, dose recording times and times of feeding should also be provided for such monitoring purposes.
