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Nutrition Support Blog: Home Nutrition Support Issues

Posted by SF8N at Dec 13, 2013 09:40 AM |
December 13, 2013
Nutrition Support Blog: Home Nutrition Support Issues

by Joe Krenitsky, MS, RD

The first several years of independent practice are a steep learning curve for most clinicians.  They are full of “Ah ha” (That’s why they taught me that!) and “Oh my” (Can that really happen?) epiphanies.  One of the more surprising things I learned when I started work, was that in the United States there is no mandatory RD intervention for patients that go home on nutrition support.  Many companies (but not all) that provide home nutrition support products and services have consultant dietitians, but I found that the degree of involvement varied based on the individuals and culture at each organization.  


When my facility started its own home nutrition support service, I was a bit reluctant to get involved because I did not have much exposure to home nutrition support and considered the ICU as my “home turf”.  However, the fates and a coworker on maternity leave eventually conspired to hurl me into the hubris of our new home nutrition support service.  Although I was well experienced in a range of GI and nutrition support issues, I soon realized that I still had a lot to learn about the world of home nutrition support.  Once I found my bearings and came to terms with the realities of not being able to get daily labs or make instant changes in medications and nutrition formulas I began to appreciate the potential of my new role.  I learned that my involvement could make a big difference for patients.  People that require long-term nutrition support have risks and problems that we rarely see while they are inpatients.  I also realized how dependent I was on the quality of information I received from inpatient facilities and the variable and occasionally dubious nature of operative reports and discharge summaries. 

Over time I began to recognize that my knowledge about the realities of home nutrition support also made me a better inpatient clinician.  I fully understood the importance of stopping intravenous fluids, cycling nutrition support, adjusting insulin and medication schedules to replicate the home regimen prior to discharge.  We revamped our inpatient guidelines for parenteral nutrition (PN) so that it was easier to make sure we were compliant with Medicare coverage for home PN. (If you need an update about reimbursement for home PN, check out the August NCP for a great review article. http://ncp.sagepub.com/content/28/5/566.long).  I also became a bit better about communicating with other caregivers and the home infusion companies.

I strongly encourage inpatient nutrition support clinicians to network and form alliances with home infusion clinicians (as well as rehab/long term care dietitians for that matter).  Home nutrition support clinicians often have the benefit of observing patients over time and have knowledge about what has been tried in the past.  If you don’t have personnel at your facility that are well versed in home nutrition support issues, consider inviting your peer from a local infusion company to discuss ways to help facilitate discharge to home nutrition support.  A better understanding of home nutrition issues will help your patients and improve your overall clinical skills.  Additionally, since we are all about to be scrutinized much more in the near future* about re-admissions to the hospital, it will behoove us all to make sure that our patients are properly prepared for discharge on home nutrition support to start with.

* http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/Readmissions-Reduction-Program.html

"Opportunities multiply as they are seized."

- Sun Tzu




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