Individualised Nutritional Care for Disease-Related Malnutrition: Improving Outcomes by Focusing on What Matters to Patients.

Delivering care that meets patients' preferences, needs and values, and that is safe and effective is key to good-quality healthcare. Disease-related malnutrition (DRM) has profound effects on patients and families, but often what matters to patients is not captured in the research, where the focus is often on measuring the adverse clinical and economic consequences of DRM. Differences in the terminology used to describe care that meets patients' preferences, needs and values confounds the problem. Individualised nutritional care (INC) is nutritional care that is tailored to a patient's specific needs, preferences, values and goals. Four key pillars underpin INC: what matters to patients, shared decision making, evidence informed multi-modal nutritional care and effective monitoring of outcomes. Although INC is incorporated in nutrition guidelines and studies of oral nutritional intervention for DRM in adults, the descriptions and the degree to which it is included varies. Studies in specific patient groups show that INC improves health outcomes. The nutrition care process (NCP) offers a practical model to help healthcare professionals individualise nutritional care. The model can be used by all healthcare disciplines across all healthcare settings. Interdisciplinary team approaches provide nutritional care that delivers on what matters to patients, without increased resources and can be adapted to include INC. This review is of relevance to all involved in the design, delivery and evaluation of nutritional care for all patients, regardless of whether they need first-line nutritional care or complex, highly specialised nutritional care.

Evaluation of over- and underfeeding following the introduction of a protocol for weaning from parenteral to enteral nutrition in the intensive care unit.

BACKGROUND: Over- and underfeeding critically ill patients have significant clinical consequences. These patients are often given a combination of enteral nutrition (EN) and parenteral nutrition (PN), potentially increasing their risk of overfeeding. No published protocol describing the process for weaning from parenteral to enteral feeding and its effects on over- and underfeeding exists. This study aimed to evaluate the introduction of such a protocol. MATERIALS AND METHODS: A prospective, 2-phase observational study was performed in a 10-bed medical/surgical intensive care unit on patients ventilated for >72 hours and receiving EN and/or PN. Data were collected 6 months before and 2 years after the implementation of a weaning protocol. Underfeeding was defined as energy intake <80% and overfeeding as >110% of estimated requirements. RESULTS: Twenty-two patients were fed for a total of 118 days in phase 1, and 29 patients were fed for a total of 272 days in phase 2. Overfeeding occurred more frequently than underfeeding prior to the introduction of the protocol (24.6% vs 19.5% of feeding days) and significantly more often on days when patients were fed by a combination of routes (P < .05). After implementing the protocol, the incidence of overfeeding reduced almost 3-fold to 9.1% (P < .001), and feeding via a combination of routes was no longer a significant cause. Underfeeding did not change and patients being adequately fed increased from 56% to 71% (P < .001). CONCLUSION: A structured protocol for weaning patients from PN to EN can reduce overfeeding in critically ill patients given nutrition support via a combination of routes.