NIAZ-Accreditation Nutrition and dietetics• Assessment of TPN indication according to EB...

‘non solum, sed etiam …’

‘niet alleen, maar ook …’netwerk AZ Sint-Lucas Brugge - AZ Zeno

NIAZ-Accreditation

Nutrition and dietetics

Dirk Bernard

medical director

AZ Sint-Lucas Brugge

Content

NIAZ standards

Legislation

Audit

Nutrition and accreditation: approach AZ Sint-Lucas

Brugge

Our projects and results

Evaluation

Current developments

Take home message

2NIAZ-accreditation Nutrition and Dietetics27/02/2016

NIAZ-accreditation and Nutrition

3

THE PROCES

NIAZ-accreditation Nutrition and Dietetics27/02/2016


NIAZ: Dutch institute for accreditation in

healthcare (www.niaz.nl )

Audit standards 2.3

NIAZ Nutritional standard: just 1? 435.02

AND:

All general accreditation standards concerning

(hospital)management

Meeting legal obligations


http://www.niaz.nl/

NIAZ Nutritional standard 435.02

Normelement 435.02

Normtekst De instelling werkt volgens de HACCP-richtlijnen/NEN-ISO 22000 bij het

inkopen, bereiden, verwerken, behandelen, verpakken, vervoeren, distribueren

en uitserveren van voedingsmiddelen en drinkwaren, waarbij zowel de

smakelijkheid en aantrekkelijkheid als de hygiëne en veiligheid zijn geborgd.

Toelichting

Categorie 4. Management van middelen

Subcategorie 3. Zorgondersteunende processen

Rubriek 5. Voedselvoorziening

Eis 3-4 Eis 3-4

NTA8009-2011

NZi Definities Veiligheid; Instelling


http://slbintranet/OenP/accreditatie/_layouts/listform.aspx?PageType=4&ListId=76C9FF4A-1EFF-48B0-AA71-3D1E60AC6BDC&ID=103&ContentTypeID=0x0100CFD471B09D2D8249B1CD5FB2B4997DD9

http://slbintranet/OenP/accreditatie/_layouts/listform.aspx?PageType=4&ListId=B04AF369-8078-4C5F-B15F-3EC136575A40&ID=46&RootFolder=*

http://slbintranet/OenP/accreditatie/_layouts/listform.aspx?PageType=4&ListId=B04AF369-8078-4C5F-B15F-3EC136575A40&ID=20&RootFolder=*

HACCP: What and when?

Legal obligations:

Hazards Analysis Critical Controle Points (HACCP)

Allergens legislation 2014

What and When:

Preparation and distribution (central kitchen, ward kitchens,

wards, one day clinics, restaurant)

Storage of food and waste (kitchens, transportation)


How?

Development, communication and implementation of

procedures

Monitoring compliance of procedures:

- Indicators

- External inspections (FAVV)

- internal audit and mini-audit?

Related standards

Prospective Risk Assessment (PRI)

Track & Trace

Performance areas (inspections, indicators, ...)


Audit nutritional standard 435.02


Nutritional procedure with control points


Track and Trace Nutrition 2015

Reporting of an incident

Tracing source of incident by (electronic) meal

registration system

More possible victims?

Tracing and informing of supplier

Eliminating the source

Improving actions taken, implementation and

evaluation



11

WHAT HAPPENED BEFORE


Nutritional policy 2009-2015

AZ Sint Lucas Brugge

Situation 2009:

14.000 admissions / 415 beds

Malnutrition not addressed (dietitians not involved)

High Total Parenteral Nutrition (TPN) usage

Nutrition and dietetics: not part of the care process

Dietitians: in kitchen manager facility services

core tasks: administration kitchen, meal

distribution, HACCP, limited paramedic activities


Projects Clinical Nutrition

2010: appointing a project leader/dietitian

managed by the medical director

Other initiatives:

2010: FOD-project Nutrition teams

2011: FOD-project Cancer plan:

1 onco dietitian (1 / 500 MOC’s (based on results 2008)

2014: FRKVA FOD Quality Indicator Malnutrition

2015: project tasks incorporated in legislation

-> KB 78 article 63 septies


Organizational changes

14

1. Projects:

- Malnutrition

- TPN

2. Introduction:

- electronic meal choice system

- electronic medical records

3. Project leader manager dietitians team

4. Dietitians moved from kitchen to clinic:

Malnutrition screening and treatment

Clinical nutrition (incl. TPN/EN) and ambulatory care


Systematic approach

Example: malnutrition project

• Plan: procedure “Treatment of malnutrition”

• Do: tasks carried out by caregivers

• Check: evaluate results

discuss results with involved units

suggest improvements

inform nutritional management team

incorporate improvement actions in procedure

• Act: implement and monitor improvements


Monitoring malnutrition screening:

results, goals and actions to improve

NIAZ-accreditation Nutrition and Dietetics 1627/02/2016

Project 2: Total Parenteral Nutrition

(TPN) 2010-2011


Project 2: TPN (a)

Tasks projectleader/dietitian

• Coordinator nutritional management team

• Detection of causes of high TPN usage

• Assessment of TPN indication according to EB guidelines

and nutritional needs and TPN advice by dietitian->

authorization of all medical specialists

• Start clinical nutrition team: monitoring of TPN/EN-patients

• TPN/EN protocols: approved by nutritional management

team


Project 2: TPN (b)

Tasks projectleader/dietitian

• Monitoring usage nb of packs, users and costs TPN/EN

• Presentation of yearly TPN/EN usage to nutritional

management team, hospital management, medical and

nursing staff

• Providing continuing education on malnutrition and

clinical nutrition (EN and TPN)


Results TPN usage

2009-2015

20

50% ↓ TPN usage and costs through follow up of TPN patients according to EB

guidelines by dietitians

0

20

40

60

80

100

120

2009 2010 2011 2012 2013 2014 2015Year

TPN costs compared to reference year 2010 (in %)

NIAZ-accreditation Nutrition and Dietetics

0

1000

2000

3000

4000

5000

6000

2009 2010 2011 2012 2013 2014 2015

Year

Evolution usage nb of TPN packs/year(2009-2015)

van Schaik R, Niewold T.A. Quality improvement and cost savings by dietitians through follow-up of patients with total parenteral nutrition during hospital admission; e-SPEN Journal 9 (2014) e59-e62

27/02/2016

Conclusion projects

Essential role of dietitians as experts in disease related

(mal)nutrition, EN and TPN

Essential organizational changes: management decisions

Improved quality and safety of care by monitoring of TPN

(and EN) patients by dietitians

Cost savings


After the projects?

Monitoring screening on malnutrition and treatment by

Electronic medical record (EMR)

TPN procedure and TP-EN instruction tools for caregivers

(physicians/dietitians) according to EB guidelines

2-yearly internal audit of nutrition and dietetics (critical

process)

Final assessment and NIAZ accreditation in 2015


Current developments?

2016

Sharing knowledge : on the job training of dietitians teams

(nutrition teams) in follow up of TPN/EN-patients

Innovating multidisciplinary projects in collaboration with

physicians: low FODMaP and pre-dialysis in ambulatory

care,…

Introduction of electronic paramedical records (ICF codes)

in medical records (KWS) organized by UZ Leuven

Transition from NIAZ 2.3 to NIAZ-Qmentum

http://www.internationalaccreditation.ca/en/home.aspx


http://www.internationalaccreditation.ca/en/home.aspx

NIAZ versus Q-Mentum

Nutritional standards?

Q-Mentum: no specific nutritional standards

Nutritional care:

is part of various standards in the total care process

is clarified in standard sets

e.g. screening on malnutrition risk and assessment of nutritional

and dietary needs


Take home 1

Revalue the nutritional process as integral part of the

patients-based care process: from admission to discharge

Monitor the nutritional process (indicators) and critical

control points

Guarantee safe care in providing (dietary) nutrition, enteral

nutrition and parenteral nutrition

Provide an approved and communicated nutrition policy,

appropriate structure and organization (clinical dietetics /

nutritional management team / clinical nutrition team)


Take home 2

Well-developed information network for procedures

and protocols available for/ communicated to all users

Continuing education about malnutrition and clinical

nutrition (EN and TPN)

Structural measurement of patient experiences,

complaints and incidents and monitoring improvements

Support of nutrition policy by management and medical

staff is essential!

26

(Clinical) Nutrition is part of the care process!


Questions?

27

Johan Roose (quality coordinator): [email protected]

Rian van Schaik (manager dietitians team): [email protected]


mailto:[email protected]

mailto:[email protected]

NIAZ-Accreditation Nutrition and dietetics• Assessment of TPN indication according to EB...

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