History of the Team How it started: 2003-2008 data collection (Dr Jeff Inciong)

Initiated by workshops? Seminars? TNT in 2003

NST workshop by FK? None

• Initiated by who and what department•FK met with admin (June 2008)• Medical Director met with core group(Nov 08)• Team was formed and formally launched (Dec 5, 2008)

We had small meetings to orient the team about forms, policies, procedural flow

History of the Team

Days in existence : 5 yrs + 11 months and 6 days

Process undergone

Lone ranger? Dr Jeff Inciong

Now, TEAM APPROACH

Sanctioned by administration? YES

Members of the TeamHEAD

Liza Francisco, MD

Rommel Lojo, MD

GS / Chief Ancillary Services

Jeff Inciong, MD

GS / Nutrition Support

Chief Dietitian (Baby Permentilla)

NST Dieitians (Ema &Zarah)

Wt Mgt Dietitian (Leahn) Clinical Pharmacists

Nurse Educators

Screening Method

BMI? YES

Additional screening criteria:

ICU patients

BMI <18.5 and >25

Tube Fed patients

Patients on TPN

Hypo alb <3.0

Modified SGA? Used in the assessment form

Nutrition Surveillance:Screened vs. Total Admissions

Number of patients admitted

Number of patients screened

Percentage of admissions screened

% pedia; % adult?; % geria? From the total census?

% underweight, % obese; % malnourished?

Screened vs Total Admissions

Inciong, JF 2008 MS Thesis

Data completion

Completion of required data

Weight - % accomplished in chart?

Height - % accomplished in chart?

Modified Subjective Global Assessment

Form used

Done by …

Nutritional Risk Screening

With the addition of 2 dietitians, Hts and Wts were encoded

daily in the computer database

At risk vs. Referred

Number of patients identified as nutritionally at risk

Number of nutritionally at risk patients who underwent nutrition assessment and risk leveling

Percentage of patients identified as nutritionally at risk that are referred to NST

0

200

400

600

800

1000

1200

Dec Jan Feb Mar Apr May June July Aug Sept Oct

TOTAL NUMBER OF ADMISSIONS

NEEDS TO BE SCREENED

TOTAL NUMBER OF SCREENED

TOTAL NUMBER OF PTS AT RISK

TOTAL NUMBER OF ASSESSED

TOTAL # of Assessed Dec-Oct: 2,409 patients

Patients at Risk vs. Patients Assessed

0

20

40

60

80

100

Dec Jan Feb Mar Apr May June July Aug Sept Oct

0.00

0.50

1.00

1.50

2.00

2.50

3.00

3.50

4.00

4.50

5.00

Dec Jan Feb Mar Apr May June July Aug Sept Oct

AT RISK VS REFERRED

Calorie Counting

Number and percent of identified nutritionally at risk patients given a calorie count

46/2487 = 1.8%

Percent of those referred to NST given a calorie count

85%

Adequacy of Intake

Number of patients reaching ≥ 75% daily calorie intake from the:

patients referred to NST

Patients identified to be at “high risk”

EN and PN

Number of patients given EN (% out of combined EN + PN)

Number of patients given PN (% out of combined EN + PN)

Number of patients given combined EN+PN

patients

Bags / bottles

Obstacles met• HMO Patients: some complaints because nutrition

assessment is not covered and is an out of pocket expense

• Assessment forms are overlooked in chart thus some high risk patients are not referred

• Need additional manpower

• Lack pedia nutrition specialist

• Lack of awareness on EN and PN guidelines

Success areas

Who encouraged the team to go on?

Remuneration?

Personal satisfaction?

Keys to SuccessStrong admin support

Harmonious relationship within the team

We love what we do!

Success Areas Research: Investigator of the Year 2009

Increased revenue for the hospital

Improved patient care and satisfaction

Comprehensive data collection

People empowerment (dietitians, nurses, pharmacists)

Computerization of FEL and Hts and Wts

Mission and Vision

VISION

To be in the forefront of nutrition support practice in the Southern Tagalog Region

To be the center for clinical nutrition practice, training and research.

To be the prime advocate for prevention and treatment of malnutrition.

MISSION To deliver quality healthcare through clinical

nutrition practice in both in- and out patients.

To prevent malnutrition in patients that are at risk of malnutrition by screening and early intervention.

To treat nutritionally-at-risk and malnourished patients by following the steps of the nutrition support process

To create and implement good nutrition practice in the hospital setting

To educate the medical and allied health professionals on the importance of nutrition support in both in and out patients

Credits MMMC Nutrition Support Team

Dietitians (for all your help w data, graphs, photos)

Baby, Zarah, Ema, Leahn, Heidi, Karen, Kathy, Leah

Nurse Educators:

Romer, JV

Dr Inciong

Dr Lojo

MMMC Administration (Dr Bobby Magsino)

NST Today

THANK YOU FOR YOUR KIND

ATTENTION