Department of Dietetics and Food Services, Mater Health, Brisbane, Queensland, Australia.
Queensland Lifespan Metabolic Medicine Services, Mater Health, Brisbane, Queensland, Australia.
Nutr Diet. 2019 Apr;76(2):141-149. doi: 10.1111/1747-0080.12517. Epub 2019 Mar 7.
This project aimed to implement consensus recommendations and innovations that improve dietetic services to promote timely referral to optimise nutritional management for adult inpatients with inborn errors of metabolism (IEM).
The i-PARIHS framework was used to identify service gaps, implement innovations and evaluate the innovations within this single-site study. The constructs of this framework are: (i) review of the evidence; (ii) recognising patients and staff knowledge and attitudes; (iii) acknowledging the local context; and (iv) the facilitators role. This included a literature review and metabolic centre service comparisons to investigate dietetic referral and foodservice processes to inform the innovation. A 12-month chart audit (6 months retrospective and prospective of implemented innovation, respectively) to evaluate newly established dietetic referral and IEM nutrition provision procedures was also completed.
The innovations implemented encompassed a clinical alert triggering urgent referral, nutrition sick day plans and metabolic diet and formula prescription via an 'alert' tab in electronic records. Eleven metabolic protein-restricted diets and nine formula recipes were introduced. Prior to the innovations, only 53% (n = 19/36) of inpatients with IEM were assessed by the dietitian and received appropriate nutrition within 24 hours. Following implementation of the innovations, 100% (n = 11/11) of inpatients with IEM received timely dietetic assessment and therapeutic nutrition.
Implementation of innovations developed using the i-PARIHS framework is effective in timely notification of the metabolic dietitian of referrals. This ensures optimal nutritional management during admissions which is required in this group of high-risk patients.
本项目旨在实施共识建议和创新，以改善营养服务，促进及时转介，优化成年代谢性疾病患者（IEM）的营养管理。
采用 i-PARIHS 框架识别服务差距，实施创新，并在该单站点研究中评估创新。该框架的结构包括：（i）审查证据；（ii）识别患者和员工的知识和态度；（iii）承认当地情况；和（iv）促进者的角色。这包括文献综述和代谢中心服务比较，以调查营养咨询和餐饮服务流程，为创新提供信息。还完成了为期 12 个月的图表审核（分别为 6 个月回顾性和前瞻性实施创新），以评估新建立的营养咨询和 IEM 营养供应程序。
实施的创新包括触发紧急转介的临床警报、营养病假计划以及通过电子记录中的“警报”标签进行代谢饮食和配方处方。引入了 11 种代谢蛋白限制饮食和 9 种配方。在创新之前，只有 53%（n=19/36）的 IEM 住院患者接受营养师评估，并在 24 小时内接受适当的营养。实施创新后，100%（n=11/11）的 IEM 住院患者及时接受了营养咨询和治疗性营养。
使用 i-PARIHS 框架开发的创新实施有效地通知代谢营养师转介。这确保了高危患者群体住院期间的最佳营养管理。
