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File: Nutrition Therapy Pdf 146621 | 01 2018 Aspen Standards For Nutrition Support Adult Hospitalized Patients
special report nutrition in clinical practice standards for nutrition support adult hospitalized patients volume00number0 xxxx 2018 1 15 c 2018 american society for parenteral and enteral nutrition doi 10 1002 ...

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                 Special Report
                                                                                                                          Nutrition in Clinical Practice
                 Standards for Nutrition Support: Adult Hospitalized Patients                                             Volume00Number0
                                                                                                                          xxxx 2018 1–15
                                                                                                                          C 2018 American Society for
                                                                                                                          Parenteral and Enteral Nutrition
                                                                                                                          DOI:10.1002/ncp.10204
                                                                                                                          wileyonlinelibrary.com
                                                1                                                2
                 AndrewUkleja, MD,AGAF ;KarenGilbert,RN,MSN,CNSC,ACNP ;
                                                                     3
                 Kris M. Mogensen, MS, RD-AP, LDN, CNSC ;ReneeWalker,MS,RD,LD,CNSC,
                 FAND4;CeressaT.Ward,PharmD,BCPS,BCNSP,BCCCP5;JoeYbarra,PharmD,
                          6                                                                 7
                 BCNSP ;BeverlyHolcombe,PharmD,BCNSP,FASHP,FASPEN                               ; Task Force
                 on Standards for Nutrition Support: Adult Hospitalized Patients, the American Society
                 for Parenteral and Enteral Nutrition
                 Abstract
                 TheAmericanSocietyforParenteralandEnteralNutritiondefinesstandardsasbenchmarksrepresentingarangeof performance
                 of competent care that should be provided to assure safe and efficacious nutrition care in most circumstances. Standards
                 are documents that define the structure needed to provide competent care. These Standards for Nutrition Support for Adult
                 Hospitalized Patients are an update of the 2010 Standards. These practice-based standards are intended for use by healthcare
                 professionals charged with the care of adult hospitalized patients receiving nutrition support therapy in any hospital with or
                 without a formal nutrition support service or team. These Standards address professional responsibilities as they relate to patient
                 assessment, diagnosis, education, care plan development, implementation, clinical monitoring, evaluation, and professional issues
                 aroundnutrition support. (Nutr Clin Pract. 2018;00:1–15)
                 Keywords
                 enteral nutrition; hospitalization; nutrition assessment; nutrition support; parenteral nutrition; standard of care
                 Introduction                                                        usuallyaddressprofessionalresponsibilitiesastheyrelateto
                 The American Society for Parenteral and Enteral Nu-                 patient assessment, diagnosis, education, care plan devel-
                 trition (ASPEN) is dedicated to improving patient care              opment, implementation, clinical monitoring, evaluation,
                 by advancing the science and practice of clinical nutri-            and professional issues. ASPEN publishes discipline-based
                 tion and metabolism. Founded in 1976, ASPEN is an                   (eg, dietitian, nurse, pharmacist, or physician) and practice-
                 interdisciplinary organization whose members are involved           based(eg,adulthospitalizedpatients,pediatrichospitalized
                 in the provision of clinical nutrition therapies, including         patients, home and alternate site care) standards. Standards
                 parenteral and enteral nutrition. With more than 6,500              arepresentedinthemostgenerictermspossible.Thedetails
                 membersfromaroundtheworld,ASPENisacommunityof                       of specific tests, therapies, and protocols are left to the
                 dietitians, nurses, pharmacists, physicians, scientists, stu-
                 dents, and other health professionals from every facet of           Fromthe 1BethIsrael Deaconess Medical Center, Division of
                 nutrition support clinical practice, research, and educa-           Gastroenterology, Boston, Massachusetts, USA; 2Thomas Jefferson
                 tion. ASPEN envisions an environment in which every                 University Hospital, Philadelphia, Pennsylvania, USA; 3Department
                 patient receives safe, efficacious, and high-quality nutrition      of Nutrition, Brigham and Womens Hospital, Boston,
                                                                                     Massachusetts, USA; 4Michael E. DeBakey Veteran Affairs Medical
                 care.   ASPENs mission is to improve patient care by               Center, Houston, Texas, USA; 5Emory Healthcare, Atlanta, Georgia,
                 advancing the science and practice of clinical nutrition            USA;6MedicalCityMcKinney,McKinney,Texas,USA;and
                 and metabolism. These Standards for Nutrition Support               7AmericanSocietyfor Parenteral and Enteral Nutrition, Silver
                 for Adult Hospitalized Patients are an update of the 2010           Spring, Maryland, USA.
                            1
                 standards. They are intended for use by any hospital with           Financial disclosure: None declared.
                 or without a formal nutrition support service (or team).            Conflicts of interest: None declared.
                    ASPEN defines standards as benchmarks representing               This article originally appeared online on xxxx 0, 0000.
                 a range of performance of competent care that should be             Corresponding Author:
                 provided to assure safe and efficacious nutrition care in           Beverly Holcombe, PharmD, BCNSP,FASHP,FASPEN,ASPEN,
                                       2
                 most circumstances. Standards are documents that define             8401Colesville Rd, Suite 510, Silver Spring, MD 20910.
                 the structure needed to provide competent care. Standards           Email: beverlyh@nutritioncare.org
            2                                                                                             Nutrition in Clinical Practice 00(0)
            discretion of individual healthcare facilities. Each health-          Chapter I: Organization
            carefacility shall strive to provide the best nutrition support       Standard 1. Nutrition Support Service (or
            care that is possible given the resources of the organization.
            The standards aim to ensure sound and efficient nutrition             Team)
            care for those in need of nutrition support therapy.                  A nutrition support service (or team) should assess and
            Important Note                                                        in collaboration with patients primary teams, manage the
                                                                                  nutrition support therapy of patients who require or may
            These standards do not constitute medical or other pro-               require nutrition support therapy. These patients are of-
            fessional advice and should not be taken as such. To the              ten, but not always, determined to be nutritionally-at-risk
            extent that the information published herein may be used              at admission or upon subsequent evaluation.3 Organized
            to assist in the care of patients, this is the result of the sole     nutrition support services (or teams) are associated with
            professional judgment of the attending healthcare profes-             improved patient outcomes, decreased length of hospital-
            sionalwhosejudgmentistheprimarycomponentof quality                    ization, and improved cost effectiveness.4-19 If a hospital
            medical care. The information presented in these standards            does not have a designated nutrition support service (or
            is not a substitute for the exercise of such judgment by the          team), the care used to provide nutrition support therapy
            healthcare professional. Circumstances in clinical settings           should be interprofessional. The scope and design of the
            and patient indications may require actions different from            nutrition support service (or team) and their respective
            thoserecommendedinthisdocumentandinthosecases,the                     activities vary according to the unique attributes of each
            judgment of the treating professional should prevail.                 hospital. Among various organizations, management of
                                                                                  nutrition support may comprise a spectrum of activities
            Audience for Standards                                                including no formal structure, an administrative nutrition
                                                                                  committeeonly, a consultative nutrition support service (or
            These practice-based standards are intended for use by                team), or a nutrition support service (or team) that assumes
            healthcare professionals charged with the care of adult               responsibility for the nutrition care of patients who receive
            hospitalized patients receiving nutrition support therapy.            nutrition support therapy.
            Level of Care                                                            1.1   When an organized nutrition support service (or
            As limited by the Important Note above, these Standards                        team) exists, it shall be directed by a clinician who
            of Practice present a range of performance of competent                        hasappropriateeducation,specializedtraining,pa-
            care that should be provided by healthcare professionals                       tient care experience, or experience in managing
            caring for adult hospitalized patients receiving nutrition                     nutrition support services (teams).
            support therapy. Terminologies included in each standard                 1.2   An organized nutrition support service (or team)
            are specified as:                                                              should include a physician, nurse, dietitian, and
                                                                                           pharmacist, each following the standards of prac-
                                                                                           tice for their discipline, as available.20-23
               (a)   “Shall”: Indicates standards to be followed strictly.           1.3   If a nutrition support service (or team) is not
               (b)   “Should”:Indicatesthatamongseveralpossibilities                       established, nutrition support therapy should be
                     one is particularly suitable, without mentioning or                   managed with an interprofessional approach that
                     excluding others, or that a certain course of action                  includes the patients physician, nurse, dietitian,
                     is preferred but not necessarily required.                            andpharmacist.
               (c)   “May”:Indicatesacourseof actionthat is permis-
                     sible within the limits of recommended practice.             Standard 2. Policies and Procedures
                                                                                  Written policies and procedures for providing nutrition
               These standards have been developed by the ASPEN                   support therapy shall be current.
            Task Force on Standards for Nutrition Support: Adult
            Hospitalized Patients, reviewed by the ASPEN Clinical                    2.1   Thepoliciesandproceduresshallbedevelopedwith
            Practice Committee, and approved by the ASPEN Board                            the input of and review by all members of the
            of Directors on July 25, 2018. These Standards of Prac-                        nutritionsupportservice(orteam)and/ornutrition
            tice should be used in conjunction with the previously                         support committee.
            published ASPEN Clinical Guidelines, Standards, Position                 2.2   The policies and procedures shall be reviewed
            Papers, and other Board Approved documents, which can                          periodically and revised as appropriate to define
            beaccessedattheASPENDocumentsLibrary,http://www.                               optimalpatientcareandtherapeuticoutcomes.(See
            nutritioncare.org/Clinical_Practice_Library/.                                  3.2.)
                 Ukleja et al                                                                                                                 3
                 Standard 3. Performance Improvement                               baseline nutrition parameters, identify nutrition risk
                 The nutrition support service (or team) and/or nutrition          factors and specific nutrition deficits, determine individual
                 supportcommitteeshallregularlyreviewandreportonser-               nutrition needs, and identify medical, psychosocial, and
                 vice performance, quality indicators, patient outcome data,       socioeconomic factors that may influence the prescription
                                                                                   andadministration of nutrition support therapy.34,35
                 and adverse events related to nutrition support therapies.24
                 These reports shall be shared with all internal stakeholders         5.1  Thenutritionassessmentshallbeperformedwithin
                 andreported to external agencies as required.                             thetimeframespecifiedbythehospitalandbya
                                                                                           dietitian or a clinician with documentedspecialized
                    3.1  Thenutrition support service (or team) and/or nu-                 expertise in nutrition.
                         trition support committee shall recommend policy,            5.2  The nutrition assessment shall include evaluation
                         procedure,orprotocolchangesthatimproveand/or                      of the patients current nutrition status and nutri-
                         enhancethesafetyandefficacyof nutritionsupport                    tion requirements.
                         therapy.                                                          5.2.1 A malnutrition diagnosis, if present, and
                    3.2  The review of service performance should assess                          degree of malnutrition shall be clearly doc-
                         the appropriateness and effectiveness of nutrition                       umented to facilitate appropriate diagnosis
                         support therapy.                                                         coding.
                 Chapter II: Nutrition Care                                                5.2.2 Degreeof obesity(ie,classI,classII,orclass
                                                                                                  III), if applicable, shall also be documented.
                 Nutrition care and the administration of nutrition support           5.3  The patients nutrition requirements shall be sum-
                 therapy shall proceed according to a series of steps with                 marized based on the findings of the nutrition
                 feedback loops. These steps include nutrition screening,                  assessment and should include energy, macronutri-
                 formal nutrition assessment, creation of a nutrition care                 ent (protein, and as appropriate, carbohydrate and
                 plan, implementation of the plan, patient monitoring, eval-               fat), as well as fluid, electrolyte, and micronutrient
                 uation of the plan, evaluation of the care setting, and                   requirements, as appropriate.
                 reformulation of the plan or termination of therapy. (See            5.4  Nutrition assessment shall include a review and
                 Figure 1: ASPEN Adult Nutrition Care Pathway.)                            documentation of factors relevant to delivery of
                                                                                           nutrition support therapy. Relevant factors may
                 Standard 4. Nutrition Screening                                           include, but are not limited to, the following: ability
                                                                                           to eat safely and adequately, patients goals, assess-
                 Nutrition screening is defined as “a process to identify                  ment of aspiration risk, functional status of the
                 an individual who is malnourished or who is at risk for                   gastrointestinal tract, cognitive function/abilities,
                 malnutritiontodetermineif adetailednutritionassessment                    enteral and vascular access, and results of tests and
                              1
                 is indicated.” Patients who are nutritionally-at-risk shall be            invasive procedures.
                 identified by a validated screening process and by periodic
                 rescreening per institutional policy or standard.3,25-33 This     Chapter III: The Nutrition Care Plan
                 processshouldbecreated,approved,andregularlyreviewed
                 by a group with organizational authority, preferably a            Standard 6. Goals
                 designated nutrition committee.                                   The process of nutrition care is multifactorial and shall
                    4.1  Results of the nutrition screening shall be docu-         include multiple levels of intervention including screening
                         mented and communicated and appropriate inter-            for nutrition risk factors. The nutrition care plan shall
                         vention shall be initiated within the time frame          be created from a comprehensive review and analysis of
                         specified by the hospital or as clinically indicated.     information gathered from many aspects of the patients
                    4.2  Aprocedure for rescreening of patients not imme-          care. The nutrition care plan should include “statements
                         diately identified as nutritionally-at-risk should be     of nutrition goals and monitoring/evaluation parameters,
                         implemented and regularly reviewed.                       the most appropriate route of administration of nutrition
                                                                                   therapy,methodof nutritionaccess,anticipateddurationof
                                                                                                                                              2
                 Standard 5. Nutrition Assessment                                  therapy, and training and counseling goals and methods.”
                                                                                      A formal nutrition assessment provides the basis for
                 All  patients   identified  as  nutritionally-at-risk  based      the nutrition care plan. The nutrition care plan guides
                 on the nutrition screening shall undergo a nutrition              comprehensive nutrition therapy by defining its ratio-
                 assessment.3,27-33 This nutrition assessment shall be             nale, describing appropriate intervention and monitoring,
                 documentedandmadeavailabletoallpatientcareproviders.              and delineating recommended reassessment and reevalu-
                 The intent of the nutrition assessment is to document             ation parameters. This process facilitates changes in care
          4                                                                                  Nutrition in Clinical Practice 00(0)
          Figure 1. The American Society for Parenteral and Enteral Nutrition adult nutrition care pathway.
          appropriate to the clinical setting while considering the     Standard 7. Interprofessional Approach
          continuumof care.Revisionof thenutritioncareplanbased         Thenutrition care plan should be developed using an inter-
          on changes in clinical status and achievement of goals of     professional team approach involving the patient, caregiver
          therapy should occur before discontinuation of nutrition      (if applicable), the nutrition support service (or team), the
          support therapy.
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