Clinical Management Nutr 564: Management Summer 2003

Clinical ManagementClinical Management

Nutr 564: ManagementNutr 564: Management

Summer 2003Summer 2003



Objectives:Objectives:

•• Review the functions of managementReview the functions of management

•• Identify unique challenges of clinicalIdentify unique challenges of clinical

management in nutrition/ dieteticsmanagement in nutrition/ dietetics

•• Review Nutrition Care Process Review Nutrition Care Process

•• Review Care PathwaysReview Care Pathways


Functions Functions

Resource management

• Allocation of resourcesTime, Physical resources, $

• Patient acuity


AcuityAcuity:

Decisions about acuity are based on sensitivity and specificity models not on universal principles.

May be determined by:

•• Diagnosis

• • Screening

• • Clinical Status


Functions Functions • Administrative dutiesAdministrative duties

BudgetPlanningStrategic PlanGoals & Objectives


Functions Functions • Personnel managementPersonnel management

Teams/ Leadership/ Organizational behaviorCulture of Health Care and DieteticsChange managementRisk managementRecruitment/ TrainingPerformance EvaluationsRetention



• Review the functions of management

•• Identify unique challenges of clinicalIdentify unique challenges of clinical

management in nutrition/ dieteticsmanagement in nutrition/ dietetics

• Review Nutrition Care Process

• Review Care Pathways


ChallengesChallengesOrganizational Structure

Health CareAncillary service



• Review the functions of management

• Identify unique challenges of clinical

management in nutrition/ dietetics

•• Review Nutrition Care Process Review Nutrition Care Process

•• Review Care PathwaysReview Care Pathways

Nutrition Care ProcessNutrition Care Process

Nutrition Care Process and Model: ADA Nutrition Care Process and Model: ADA adopts road map to care and outcomes adopts road map to care and outcomes managementmanagement

Lacey K, Pritchell E, JADA 2003;103:1061-72


Four Distinct Steps Four Distinct Steps

Not a linear relationship but based on critical thinking

Nutritional AssessmentNutritional Assessment

Nutrition DiagnosisNutrition Diagnosis

Nutrition InterventionNutrition Intervention

Nutrition Monitoring and EvaluationNutrition Monitoring and Evaluation


Lacey K, Pritchell E, JADA 2003;103:1061-72


Consistent components and formats: Consistent components and formats:

• Definition and Purpose

• Key components or substeps with examples as appropriate

• Critical thinking characteristics

• Documentation elements

• Considerations for continuation, discontinuation, or discharge of care


How does this differ from MNT?How does this differ from MNT?

Some commonalities:

Consistent

Standardized

Four-step process

Process implemented differently in MNT types of service

MNT always involves comprehensive assessment and individualized care

Nutrition Care PlansNutrition Care Plans

Internal documents to support patient careInternal documents to support patient care

Summary of relevant patient information

Problem oriented

Problem orientedProblem oriented

Problem #1 - Medication induced Diabetes

Problem #2 - Uncontrolled HTN

Problem #3 - Social Support


Documentation should support the Nutrition Care Process

What information needs to be consistently tracked and recorded?


Patient Management:Patient Management:

Information management

Goals and Objectives

Clinical PathwaysClinical Pathways


Also known as:

Critical paths

Critical pathways

Care paths


“Management plans that display goals for patients and provide the sequence and timing of actions necessary to achieve these goals with optimal efficiency”

Every NR et al. Circulation 2000;101:461-5.


Select the best practice when practice varies unnecessarily Defining the standards for the expected duration of hospital stay and for the use of tests and treatment Examining the interrelations among the different steps in the care process to find ways to coordinate or decrease the time in the rate-limiting step Giving all hospital staff a common game plan from which to view and understand their various roles in the overall care process Providing a framework for collecting data on the care

process so that providers can learn how often and why patients do not follow an expected course during their hospitalization Decreasing documentation burdens Improving patient satisfaction with care by educating patients and their families about the plan of care

Pearson SD, et al.: Ann Intern Med 1995;123:941-8.


Care delivery tool similar diagnosesCare delivery tool similar diagnoses

Identify level of care

Members of Health Care Team

Specifies time of intervention

Incorporates discharge planning and education


BenefitsBenefits

Uniform care / reduces variation in care

Improves communication

Facilitates documentation

Supports quality assurance efforts


LimitationsLimitations

Only useful if properly used in a timely fashion

Flexibility

Often many of the processes have not been tested

Not all variation is negative

Not an end in itself

Allow for identification of problems


Steps in developing a care pathwaySteps in developing a care pathway Select a topic Select a team Evaluate the current process of care Evaluate medical evidence and current practiceDetermine the critical pathway formatAlgorithmInclude documentation on the pathway

Document and analyze variance Pathway implementationContinuous Quality Improvement


Examples: Information on patient’s nutritional care

Admission:

Screening -

Baseline data - Ht, Wt, IBW,

Nutritional Assessment - at risk statement

During hospitalization:Interactions

* Diet Instruction* Nutrition Support


Examples: Information on patient’s nutritional care

Discharge Planning:EducationPlan for follow-up

Documents

Clinical Management Nutr 564: Management Summer 2003