School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, Queensland, Australia.
Nutrition & Dietetics, Logan hospital, Logan, Queensland, Australia.
Nutr Diet. 2018 Sep;75(4):397-405. doi: 10.1111/1747-0080.12429. Epub 2018 Apr 30.
Refeeding syndrome (RFS) prevalence rates vary across studies depending on the criteria used for assessment and identification. For registered dietitians, the assessment and management of RFS is highly reliant on daily serum electrolyte values; however, registered dietitians working within Australia do not currently possess laboratory test ordering privileges. We aimed to examine the opinions of registered dietitians regarding RFS identification, management and guidelines and the option of using extended scope of practice to order electrolyte monitoring autonomously.
A multi-method action research approach was used, incorporating two projects. The first was a survey examining Australian registered dietitians' (n = 187) opinions regarding RFS identification, management and guidelines, and autonomous electrolyte monitoring. To establish if results were similar internationally, an interview was conducted with 22 registered dietitians working within 10 different countries. Data were analysed using chi-square tests and thematic analysis.
Australian registered dietitians (75%) identify patients at risk of RFS at a high rate of more than once per fortnight, with 74% reporting that they have previously worked with a patient diagnosed with RFS. Results varied internationally, with respondents from eight countries reporting that RFS is a problem within acute care versus respondents from five countries having never treated a patient with RFS. The majority (≥89%) of registered dietitians desire new guidelines and the option to order patient electrolyte monitoring autonomously.
Our findings suggest that more stringent tools for the identification of RFS are necessary. There was limited uniformity across countries, and updated practice guidelines are needed.
由于用于评估和识别的标准不同，再喂养综合征（RFS）的患病率在不同研究中有所差异。对于注册营养师来说，RFS 的评估和管理高度依赖于日常血清电解质值；然而，澳大利亚的注册营养师目前没有进行实验室检测的权限。我们旨在研究注册营养师对 RFS 识别、管理和指南的意见，以及自主进行电解质监测的扩展实践范围的选择。
采用多方法行动研究方法，包括两个项目。第一个是一项调查，调查了澳大利亚注册营养师（n=187）对 RFS 识别、管理和指南以及自主电解质监测的意见。为了确定国际上的结果是否相似，对来自 10 个不同国家的 22 名注册营养师进行了访谈。使用卡方检验和主题分析对数据进行分析。
澳大利亚注册营养师（75%）以高于每两周一次的频率识别出有 RFS 风险的患者，其中 74%报告说他们曾与被诊断患有 RFS 的患者一起工作过。国际上的结果有所不同，8 个国家的受访者报告说 RFS 是急性护理中的一个问题，而来自 5 个国家的受访者从未治疗过 RFS 患者。大多数（≥89%）注册营养师希望有新的指南，并希望能够自主为患者进行电解质监测。
我们的研究结果表明，需要更严格的 RFS 识别工具。各国之间的一致性有限，需要更新的实践指南。
