Enteral and Parenteral Order Writing Survey-A Collaborative Evaluation Between the Academy of Nutrition and Dietetics' Dietitians in Nutrition Support Dietetics Practice Group and the American Society for Parenteral and Enteral Nutrition (ASPEN) Dietetics Practice Section.

INTRODUCTION: In 2014 and 2017, the Centers for Medicare and Medicaid Services authorized nutrition-related ordering privileges for registered dietitian nutritionists (RDNs) in hospital and long-term care settings, respectively. Despite this practice advancement, information describing current parenteral nutrition (PN) and enteral nutrition (EN) ordering practices is lacking. Dietitians in Nutrition Support, a dietetic practice group of the Academy of Nutrition and Dietetics and the Dietetics Practice Section of the American Society of Parenteral and Enteral Nutrition (ASPEN) utilized a survey to describe PN and EN ordering practices among RDNs in the United States. METHODS: A cross-sectional study design was utilized to describe RDN PN and EN ordering privileges. Respondents were asked to describe PN and EN ordering privileges, primary practice setting, primary patient population served, nutrition specialty certification, highest degree earned, career length, and, if applicable, the nature of prior denials for ordering privileges or reasons for not applying for ordering privileges. RESULTS: Seven hundred two RDNs completed the survey (12% response rate), with 664 RDNs providing complete data. The majority of respondents (n=558) cared for adult/geriatric patients. Among this subset, 47% had no PN ordering privileges; 14% could order and sign PN; 28% could order PN with provider cosignature; and 10% could order partial PN with provider cosignature. Nineteen percent of RDNs had no EN ordering privileges; 37% could order and sign EN; and 44% could order EN with provider cosignature. RDNs with ordering privileges were more likely to have a nutrition specialty certification and work in an academic or community hospital setting. CONCLUSION: PN and EN ordering privileges are varied because of institution and state requirements. Future research describing the outcomes associated with RDN ordering privileges is needed. This article has been approved by the Academy's Research, International, and Scientific Affairs team and Council on Research and the ASPEN Board of Directors. This article has been co-published with permission in Nutrition in Clinical Practice. The articles are identical except for minor stylistic and spelling differences in keeping with each journal's style. Either citation can be used when citing this article.

Enteral and Parenteral Order Writing Survey-A Collaborative Evaluation Between the Academy of Nutrition and Dietetics' Dietitians in Nutrition Support Dietetics Practice Group and the American Society for Parenteral and Enteral Nutrition (ASPEN) Dietetics Practice Section.

INTRODUCTION: In 2014 and 2017, the Centers for Medicare and Medicaid Services authorized nutrition-related ordering privileges for registered dietitian nutritionists (RDNs) in hospital and long-term care settings, respectively. Despite this practice advancement, information describing current parenteral nutrition (PN) and enteral nutrition (EN) ordering practices is lacking. Dietitians in Nutrition Support, a dietetic practice group of the Academy of Nutrition and Dietetics and the Dietetics Practice Section of the American Society of Parenteral and Enteral Nutrition (ASPEN) utilized a survey to describe PN and EN ordering practices among RDNs in the United States. METHODS: A cross-sectional study design was utilized to describe RDN PN and EN ordering privileges. Respondents were asked to describe PN and EN ordering privileges, primary practice setting, primary patient population served, nutrition specialty certification, highest degree earned, career length, and if applicable, the nature of prior denials for ordering privileges or reasons for not applying for ordering privileges. RESULTS: Seven hundred two RDNs completed the survey (12% response rate), with 664 RDNs providing complete data. The majority of respondents (n = 558) cared for adult/geriatric patients. Among this subset, 47% had no PN ordering privileges; 14% could order and sign PN; 28% could order PN with provider cosignature; 10% could order partial PN with provider cosignature. Nineteen percent of RDNs had no EN ordering privileges; 37% could order and sign EN; 44% could order EN with provider cosignature. RDNs with ordering privileges were more likely to have a nutrition specialty certification and work in an academic or community hospital setting. CONCLUSION: PN and EN ordering privileges are varied because of institution and state requirements. Future research describing the outcomes associated with RDN ordering privileges is needed. This paper has been approved by the Academy's Research, International, and Scientific Affairs team and Council on Research and the ASPEN Board of Directors. This article has been co-published with permission in the Journal of the Academy of Nutrition and Dietetics. The articles are identical except for minor stylistic and spelling differences in keeping with each journal's style. Either citation can be used when citing this article.

Hospital Nutrition Assessment Practice 2016 Survey.

BACKGROUND: Malnutrition is a significant problem for hospitalized patients in the United States. Nutrition assessment is an important step in recognizing malnutrition; however, it is not always performed using consistent parameters. METHODS: A survey among U.S. American Society for Parenteral and Enteral Nutrition (ASPEN) members was conducted to collect data on nutrition assessment parameters used in hospitals and to establish how facilities use their electronic health record (EHR) to permit data retrieval and outcome reporting. RESULTS: The survey was developed by the ASPEN Malnutrition Committee and was sent to 5487 U.S. ASPEN members, with 489 responding for a 9% response rate. Ninety-eight percent of adult and 93% of pediatric respondents indicated a registered dietitian completed the nutrition assessment following a positive nutrition screen. Variables most frequently used among adult respondents included usual body weight, ideal body weight, and body mass index. Among pediatric respondents, weight-for-age and height-for-age percentiles and length/height-for-age percentile were most frequently used. Both adult and pediatric respondents indicated use of physical assessment parameters, including muscle and fat loss and skin assessment. Eighty-seven percent of adult and 77% of pediatric respondents indicated they are using the Academy of Nutrition and Dietetics (Academy) and ASPEN Consensus Malnutrition Characteristics for Adult and Pediatric Malnutrition, respectively. Overall, 97% of respondents indicated nutrition assessment documentation was completed via an EHR. Of all respondents, 61% indicated lack of clinical decision support within their EHR. CONCLUSION: This survey demonstrated significant use of the Academy/ASPEN malnutrition consensus characteristics.

The impact of early enteral nutrition on pediatric acute respiratory failure.

BACKGROUND AND AIMS: Children who are critically ill undergo metabolic stress and it is important that they receive adequate calories and protein in order to recover. Our objective was to investigate the impact of early enteral nutrition (EEN) on pediatric intensive care (PICU) patients with acute respiratory failure. METHODS: A retrospective cohort study was performed on all patients admitted to a 20 bed PICU at a tertiary children's hospital over a 30 month period. Inclusion criteria were: intubation on admission or within 24 h of admission, ventilation over 48 h and enteral nutrition initiated on ventilatory support. Baseline patient characteristics and nutritional, ventilatory and overall outcome data were collected. Subgroup analysis was performed comparing those that received EEN (goal in 72 h) and those that did not. RESULTS: Patients that received EEN had a shorter PICU and overall length of stay 8.7 vs 10.7 and 17.5 vs 22; p < 0.05 and received a higher percentage of goal Kcal and protein (71 vs 54, and 61 vs 51%, p < 0.002) in the PICU. After adjusting for age and severity of illness, EEN was still associated with decreased PICU and overall length of stay. More patients with feeding intolerance were on vasoactive agents (33 vs 9%, p = 0.02), but intolerance was not associated with use of motility agents or degree of respiratory failure. Feeds were interrupted in 19% of patients, most commonly for procedures. CONCLUSIONS: In PICU patients with acute respiratory failure, EEN is associated with shorter PICU and overall length of stay and delivery of higher percentage of goal Kcal and protein by tube feeds. Feeds are commonly interrupted despite efforts to achieve EEN and patients receiving vasoactive agents have feeds held more commonly for perceived intolerance.

The Gynecologic Health Consequences of Chlamydia trachomatis Infection in Military Servicewomen.

Chlamydia trachomatis is the most common sexually transmitted bacterial infection in the United States. Within the U.S. military, the age- and race-adjusted chlamydia infection rates among female service members are consistently higher than civilian rates, with a 20% annual acquisition rate among young active-duty women. The sequelae of chlamydia disproportionately impact women in terms of severity and cost. Untreated chlamydia progresses to pelvic inflammatory disease in 40% of cases, and is a leading cause of fallopian tube damage and pelvic adhesive disease resulting in ectopic pregnancy, tubal infertility, and acute and chronic pelvic pain. Tubal infertility is among the leading indications for in vitro fertilization (IVF) nationally and rates among couples undergoing IVF at military treatment centers are double the national average. Collectively, chlamydia infection represents a significant resource burden to the military health care system and, in view of the serious gynecologic health sequelae, a significant threat to the readiness of servicewomen. In this review, we discuss the gynecologic impact of chlamydia infection within the military, the critical gaps for research funding, and opportunities for intervention.