An effective nutritional support team requires multiple disciplines working in collaboration in order to deliver safe and cost effective support:
Nutritional support may be provided through either entering liquid formula directly into the gut (enteral nutrition) or directly into the bloodstream via parenteral nutrition (PN). Once an assessment of individual needs has been performed, appropriate routes of administration will be selected according to current evidence.
Nutrition Support Professionals
Nutrition support professionals include dietitians, nurses, pharmacists, physicians and advanced practice providers. Together they form part of a multidisciplinary team providing enteral and parenteral nutrition services for patients of all ages across various settings.
RDNs play an integral part in nutrition support teams or interprofessional groups, offering expertise to identify malnutrition risks, identify macro- and micronutrient requirements, as well as type and route of nutritional therapy (for instance nasogastric tube vs nasojejunal tube or tunneled catheter vs port). Self-evaluation using focus area standards should be regularly practiced for competency assessment and expansion in nutrition support practices.
Nutrition support professionals must adhere to the principle of equity in providing quality nutrition care without discrimination based on race, language, religion, political or other opinions, social origin or any other status factors.
Dietitians
Dietitians (also referred to as registered dietitians or RDNs) are the only nutrition professionals trained specifically in assessing, diagnosing and treating nutritional disorders. Their services can be found in hospitals, long-term care facilities, outpatient clinics and private practices; additionally they have roles in education, research, food service management, public health policy development as well as with private healthcare insurers.
Dietitians possess at least a bachelor’s degree from an ACEND-accredited program in clinical nutrition or dietetics and must complete at least 1,200 hours of practical supervised experience prior to being eligible to sit the Commission on Dietetic Registration’s registered dietitian exam.
The Health Care Professions Council is an independent UK-wide health regulator which maintains a register of healthcare professionals, taking action against those who fail to meet minimum standards. Dietitians who wish to maintain APD status must join Dietetic Association membership and complete its Continuing Professional Development program for ongoing professional growth.
Nurses
Nurses are an essential element of any nutrition support team. Their role includes overseeing patients’ nutritional status, providing education to both the patient and caretaker, coordinating care with other providers and identifying barriers that impede optimal nutrition.
Nursing professionals are charged with informing patients about healthy eating habits and encouraging them to share family-style meals whenever possible. Furthermore, they must assess each patient’s symptoms and ensure adequate fluid intake is received by each.
Nurses play a vital role in creating nutritional-focused policies and setting standards across hospitals. Their operational accountability lies with the lead consultant of the NST while professionally, their department head. Furthermore, nurses often collaborate closely with nutrition support specialists in order to provide continuity of care.
Pharmacists
An NST is essential to providing safe parenteral nutrition in hospitals, operating under the guidance of a nutrition steering committee and comprising multidisciplinary members such as nurses, dieticians and pharmacists.
Pharmacists are trained professionals with expertise in assessing, prescribing and dispensing medications. They often work at community pharmacies, hospitals or ambulatory care clinics and may have advanced postgraduate residency and fellowship training in specializations such as oncology critical care or nuclear pharmacy.
Clinical pharmacists are an increasingly prevalent presence worldwide and their interventions have been demonstrated to significantly enhance patient outcomes while simultaneously decreasing costs. Their efforts often revolve around preventing drug interactions or adverse drug events (ADE), optimizing dosing of medication and making nutritional support prescription compatible with any other drugs being given in the same body fluids.
Other Healthcare Practitioners
Physicians provide nutrition support by screening and assessing patients, creating and implementing feeding care plans, monitoring appropriateness and duration of nutritional therapy and determining when it should end or continue. They may also instruct both patients and caregivers how to insert enteral and parenteral feeding tubes.
Physician assistants (PAs) are nationally certified, state-licensed healthcare professionals that work collaboratively with physicians on healthcare teams. PAs can prescribe medications including nutrition support solutions.
Nurse practitioners (NP) are graduate-trained nurses who specialize in either family medicine (FNP), adult care (NP) or geriatrics (GNP). Nurse practitioners may prescribe medications including nutrition support solutions.
Registered dietitians conduct comprehensive, individual nutrition evaluations that include an evaluation of any underlying diseases, nutrition needs calculation and designing of an individualized feeding regimen tailored specifically to patients/carers needs as well as monitoring any complications that arise with tube feeding (refeeding syndrome or otherwise).
