[Does the nutritional care plan and report upon discharge under the health care system substitute the nutrition support team summary at patient discharge?].

Our nutrition support team (NST) designed the NST summary for cooperation among personnel providing medical care for nutritional management of high-need patients in our area. After the introduction of the NST fee under the health care system, the number of summary publications decreased. The requested NST fee is necessary for publication of a nutritional care plan and report upon patient discharge. We hypothesized that the nutritional care plan and discharge report were being substituted for the NST summary at the time of patient discharge. We retrospectively investigated 192 cases with NST fee. There were only 13 cases of overlapping publication, and the NST summary was necessary for 107 of 179 cases in which no NST summary had been prepared. Since the space on the report form is limited, it can provide only limited information. However, the NST summary can convey detailed supplementary information. Therefore, there is a high need for the NST summary, and publication of NST summaries for the appropriate cases must continue.

[Case report--cooperation among medical staff to improve home enteral nutrition and increase hope in a patient with dementia].

Herein, we describe the case of a man in his 70s who had slight dementia. Because of dysphagia, the patient received enteral nutrition by gastrostomy. The patient wished to care for his wife, who had severe dementia and was also receiving enteral nutrition. He was later re-hospitalized for aspiration-related pneumonia. At this point, it was discovered that the management of enteral nutrition via gastrostomy was different from that at the time of discharge from our hospital. Nutritional management during home care may change for various reasons after discharge from hospital. If a change is identified at the time of re-hospitalization, this process should be confirmed. In addition, it is necessary that any changes in nutritional management should benefit the patient. In order to improve the home care of the present patient, we changed his diet to semisolid enteral nutrition that was easier for him to manage. This diet would also be beneficial for the aspiration-related pneumonia. Importantly, we shared these changes in enteral nutrition with all medical staff involved in his care. This included explaining changes in nutritional content, dose, and method of delivery.