DIETETIC RESEARCH ABSTRACTSdietetics-landfood.sites.olt.ubc.ca/files/2015/02/Research-Abstract... · abstracts found here, interns prepare a final paper and present their findings

DIETETIC RESEARCH ABSTRACTS

FACULTY OF LAND AND FOOD SYSTEMS


2016/17


INTRODUCTION

The UBC Dietetics Major is pleased to share the 2016-2017 internship Research Module abstracts. These abstracts summarize the research projects interns completed between September 2016 – June 2017. Committed dietitian research preceptors from various health authorities and organizations throughout British Columbia provide oversight and guidance as interns progress through the research process. In addition to the abstracts found here, interns prepare a final paper and present their findings at the UBC Dietetic Intern Research Symposium each Spring.

Interns are eligible to enter the dietetic workforce in June 2017. With them, they bring the skills, knowledge and attitudes to initiate their own practice-based research. This important component of professional practice can support their careers as they skillfully integrate theory and critical thought into practice, pushing the profession forward as they continue to learn, experience and reflect on their own practice as dietitians.

We would like to thank our program’s Research Advisory Committee, who, behind the scenes, review intern research project proposals and provide essential input into all aspects of the program’s Research Module.

The hope is that you enjoy reading these abstracts, that they help stimulate thought about dietetic practice and inspire you to take on your own research regardless of your previous research experience.

Congratulations to our 2016-2017 UBC Dietetics Major interns for all your work on your research.

We invite you to contact us should you have inquiries about our intern research.

Tamar Kafka, MSc RD, UBC Dietetics Education Coordinator, [email protected]

Heather Tufts, MSc RD, UBC Dietetics Education Coordinator (2016-2017), [email protected]

Kara Vogt, MEd RD, UBC Dietetics Practice Educator, [email protected]

Visit our website at landfood.ubc.ca/dietetics for information about the UBC Dietetics Major.

mailto:[email protected]



http://dietetics-landfood.sites.olt.ubc.ca/preceptors/ubc-clinical-instructor-appointments/


TABLE OF CONTENTS

CHARACTERISTICS OF ADULTS ON HOME ENTERAL NUTRITION WHO DID AND DID NOT RECEIVE REGISTERED DIETITIAN FOLLOW-UP 1

K DOSANJ, G HO, P POON, M VURZINGER, D SARAN, K VANDOP, W HUSSAIN, H TUFTS, R SANDHU FRASER HEALTH CORE SITE

NUTRITIONAL ADEQUACY OF CUSTOMIZED RESIDENTIAL CARE MENUS: RETHERM SITES 2

A ELLIS, S GOH, J KAILE, E ZHANG, L DA SILVA, D MCKAY, T MOFFITT, J SETO, K VOGT, B WOODBURN FRASER HEALTH CORE SITE

USE OF THE NUTRITION SCREENING COMPONENT OF THE 48/6 ADMISSION HISTORY FORM AT ROYAL INLAND HOSPITAL (RIH) AND KELOWNA GENERAL HOSPITAL (KGH) 3

M ALEXANDER, J JACOBSEN, J LEESING, S ROSENAU, H DRAPER, M KARLSSON, M KENNEDY

H TUFTS INTERIOR HEALTH CORE SITE

ARE ISLAND HEALTH HOME AND COMMUNITY CARE CLIENTS IDENTIFIED WITH MALNUTRITION-RELATED RISK FACTORS BEING REFERRED TO A DIETITIAN: A RETROSPECTIVE CHART REVIEW 4

T DUGGAN, L MONTY, F REINBOLT, C WONG, A WYCHE, M CARLSON, J LE PATOUREL, E MESSING M PARROTT, H TUFTS ISLAND HEALTH CORE SITE

OBSERVATION OF MEALTIME ENVIRONMENTS IN NORTHERN HEALTH LONG-TERM CARE FACILITIES: DIETETIC INTERN RESEARCH PROJECT 5

K BOGH, L BURTON, E BRANCO, L KRAITBERG, S FINCH, H TUFTS NORTHERN HEALTH CORE SITE

A DESCRIPTION OF WEIGHT TRENDS AND METABOLIC SYNDROME RISK FACTORS IN THE ALDER TERTIARY MENTAL HEALTH UNIT POPULATION 6

N KONTOGIANNIS, M YELLAND-DESYLVA, H TUFTS, K VOGT, C ADAIR, F JOHNSON, JC KOH

C KWAN PROVIDENCE HEALTH CARE CORE SITE

KNOWLEDGE AND ATTITUDES OF PHYSICIANS AND NURSES TOWARD ENTERAL FEEDING ON A GENERAL MEDICINE WARD 7

H LAU, L POLZER, M STEELE, V LEWIS, J THORNHILL, F JOHNSON, JC KOH, H TUFTS PROVIDENCE HEALTH CARE CORE SITE

A DESCRIPTION OF ONCOLOGY PATIENTS WHO ARE AT RISK FOR MALNUTRITION UPON ADMISSION AT THE BC CANCER AGENCY 8

S MAHERALI, C POLLOCK, H TUFTS, R LEVY-MILNE, S SEKHON PROVINCIAL HEALTH SERVICES AUTHORITY

HOMEMADE BLENDERIZED TUBE FEEDING: DIETITIANS SURVEYED 9

K BELL, C BELLAMY, J LAU, K YEE, C KARIYA, H TUFTS VANCOUVER COASTAL HEALTH


SUITABILITY OF PREMIXED PARENTERAL NUTRITION SOLUTIONS TO MEET NUTRITIONAL NEEDS OF HOSPITALIZED SURGICAL PATIENTS AT VANCOUVER GENERAL HOSPITAL 10

E HUANG, A LAM, K LANDRIGAN, J MAH, T CIVIDIN, M RADHAKRISHAN VANCOUVER COASTAL HEALTH

DIETETIC RESEARCH ABSTRACTS 1

CHARACTERISTICS OF ADULTS ON HOME ENTERAL NUTRITION WHO DID AND DID NOT RECEIVE REGISTERED DIETITIAN FOLLOW-UP K DOSANJ

1, G HO1, P POON

1, M VURZINGER1, D SARAN

2, K VANDOP2, W HUSSAIN

2 H TUFTS

1, R SANDHU2

1UBC DIETETICS PROGRAM

2FRASER HEALTH

FRASER HEALTH CORE SITE Background: Inadequate research exists regarding home enteral nutrition (HEN) patients in Canada. There is currently a lack of data examining the HEN population within Fraser Health (FH), and their rates of registered dietitian (RD) follow-up. Objectives: The objectives of this study are to describe the demographic and clinical characteristics of adult patients on HEN with a long-term feeding tube placed in a FH facility, and examine the proportion of patients who received follow-up from a home health or outpatient RD. This study will then analyze the differences in characteristics between HEN patients who received RD follow-up and those who did not. Methods: A retrospective chart review was completed to retrieve data for adult patients who had a long-term feeding tube placed at a FH facility between April 1, 2012 and March 31, 2015. Patient profiles were obtained from FH Health and Business Analytics (HBA) and filtered to confirm fulfillment of the inclusion criteria. Demographic, clinical and RD follow-up data was extracted from the Electronic Medical Record (EMR) and reports sent from HBA. Descriptive statistics were calculated to describe the population and distinguish any differences between patients who were and were not seen by a RD after hospital discharge. Results: A total of 235 patients were included in the study. The study population was predominantly male (61%) with a mean age of 66 years (SD 17, range 20-93). Thirty nine percent of HEN patients live in Surrey. The majority of patients had gastric (73%) long term feeding tubes, compared to jejunal tubes. Of the 235 patients, 119 (51%) patients had RD follow up after discharge. Of those who did receive RD follow up, 61 patients (51%) had outpatient follow-up, while 53 patients (45%) received home health follow up. The remaining 5 (4%) patients received RD follow up from other sources. Implications & Conclusion: This study describes a previously unstudied population in British Columbia’s largest health authority. The results of this study and future research on this topic will help to determine whether sufficient medical nutrition therapy is available to HEN patients in FH communities and advocate for additional home health and outpatient RD services.


NUTRITIONAL ADEQUACY OF CUSTOMIZED RESIDENTIAL CARE MENUS: RETHERM SITES A ELLIS

1, S GOH1, J KAILE

1, E ZHANG1, L DA SILVA

2, D MCKAY2, T MOFFITT

2, J SETO2

K VOGT1, B WOODBURNE

2, 1UBC DIETETICS PROGRAM, VANCOUVER

2FRASER HEALTH

FRASER HEALTH CORE SITE Background: Fraser Health (FH) standardized residential care (RC) menus are based on Canada’s Food Guide, which is designed for healthy individuals > 50 years. The average age of those in FH RC is > 80 years. It is unknown if menu customization to accommodate individual preferences and therapeutic requirements compromises their nutritional adequacy. Objective: To examine the protein, riboflavin, fibre, vitamin D, folate, and calcium content of customized FH RC menus and compare it to the respective Recommended Dietary Allowance (RDA) and Adequate Intake (AI) values. Methods: The micronutrient content of the 28-day electronic customized menus of 426 residents

from 5 FH facilities was analyzed using CBORD® and ExcelⓇ. The analysis included meals,

therapeutic snacks and oral nutrition supplements. Results: The patient mean age was 86 years (SD ± 7, range 71-105 years). Of the 426 menus, 99.8% (n = 425) met the RDA for protein and 99.3% (n = 423) met the RDA for riboflavin. In contrast, the RDA/AI for calcium, fibre, folate and vitamin D was only met 55.6% (n = 237), 17.1% (n = 73), 3.52% (n = 15), and 0.5% (n = 2) of the time, respectively. Implications & Conclusions: Almost all customized menus are nutritionally adequate in protein and riboflavin. Inadequate provision of fiber may contribute to constipation, which is a frequent problem in the geriatric population. The calcium and vitamin D content of the menus is of concern given the high prevalence of osteoporosis with advanced age. Few menus met the RDA for folate, which may present a risk for macrocytic anemia. Almost no menus met the RDA for vitamin D. This study did not assess whether calcium, folate or vitamin D levels are being augmented through micronutrient supplementation. These findings may help dietitians justify supplementation and inform revisions of the menu.


USE OF THE NUTRITION SCREENING COMPONENT OF THE 48/6 ADMISSION HISTORY FORM AT ROYAL INLAND HOSPITAL (RIH) AND KELOWNA GENERAL HOSPITAL (KGH) M ALEXANDER

1, J JACOBSEN1, J LEESING

1, S ROSENAU1, H DRAPER

2, M KARLSSON3

M KENNEDY4, H TUFTS

1

1UBC DIETETICS PROGRAM, VANCOUVER

2INTERIOR HEALTH AUTHORITY, CLINICAL NUTRITION, KELOWNA

3INTERIOR HEALTH AUTHORITY, POPULATION HEALTH, KELOWNA

4INTERIOR HEALTH AUTHORITY, CLINICAL NUTRITION, KAMLOOPS

INTERIOR HEALTH CORE SITE Background: The 48/6 Admission History form (AHF) is a screening tool used across Interior Health (IH) acute care hospitals that provides information regarding a patient’s functional abilities prior to admission. It covers six functional areas of health, including nutrition and swallowing. Nutrition screening helps determine if a patient is at risk for malnutrition. If a patient is determined to be at risk, an appropriate follow up action should be implemented within 48 hours.

Objective: This study determined how often the nutrition and swallowing section of the AHF was completed and what steps were taken, if any, to address the identified nutrition risk(s). Methods: This retrospective chart review used convenience sampling of 300 patient charts. Data collected included completion of 4 nutrition/swallowing questions, information transfer to the care plan, and specific actions when deemed appropriate. Data was collected from paper charts and electronic health records. Descriptive statistics were used to describe the results as proportions. Results: The AHF was available and dated within 24 hours 65% of the time; however, the nutrition/swallowing section was completed 57% of the time. The following actions were completed: 25% received a Speech Language Pathology (SLP) consult, 2% % had Medpass ordered, 9% % had oral nutrition supplements ordered, 5% had high protein high calorie diets ordered, 54% had diet type/food preferences entered. When nutrition risk was identified, 22% had a Registered Dietitian (RD) consult ordered. Accurate transfer of information to the care plan was completed 22% of time. Implications & Conclusions: Further education for nursing and allied health staff on the importance and appropriate use of the tool is required to identify at risk patients and implement appropriate actions to reduce malnutrition. This study suggests that the nutrition/swallowing section of the AHF is not being properly completed or utilized for follow up actions by nursing staff.


ARE ISLAND HEALTH HOME AND COMMUNITY CARE CLIENTS IDENTIFIED WITH MALNUTRITION-RELATED RISK FACTORS BEING REFERRED TO A DIETITIAN: A RETROSPECTIVE CHART REVIEW

T DUGGAN1, L MONTY

1, F REINBOLT1, C WONG

1, A WYCHE1, T DUGGAN

1 M CARLSON

2, J LE PATOUREL2, E MESSING

2, M PARROTT2, H TUFTS

1


2ISLAND HEALTH

ISLAND HEALTH CORE SITE Background: Appropriate nutrition screening and dietitian support in home and community care

(HCC) has been shown to prevent/shorten hospital stays. Island Health (VIHA) HCC uses the

Resident Assessment Instrument – Home Care (RAI-HC) screening system. Presently, nutrition

risk status of VIHA HCC clients is unknown. The RAI-HC’s nutrition questions are not validated,

and its ability to generate appropriate nutrition referrals is not well established.

Objectives: This study aims to describe the VIHA HCC population by identifying clients

presenting with malnutrition-related risk factors, and determine the proportion referred to a HCC

dietitian.

Methods: Through convenience sampling, 680 VIHA-HCC-client Primary Access Regional

Information System (PARIS) health records with RAI-HC from February 1 – March 31, 2015 were

retrospectively reviewed. Medical Record Number, age, gender, RAI-HC date, unintended weight

loss, severe malnutrition/cachexia (SM/C), appetite loss, PARIS team, and referral data (February

1, 2015 – March 31, 2016) were collected. Relevant RAI-HC data was compared to the

Malnutrition Screening Tool (MST) to assess nutrition risk.

Results: Mean age was 82: 59% (n=403) female, 41% (n=277) male. Geographical residence:

14% (n=96) North Island, 39% (n=263) Central and 47% (n=321) South. From all clients (n=680),

3.5% (n=24) received dietitian referrals. From clients with SM/C data (97%, n=660), 2% (n=14)

were flagged “yes”; of these, 14% (n=2) received dietitian referrals. From clients with both

unintended weight loss and appetite loss data (17%, n=114), 25% (n=28) were at nutrition risk

per the MST; of these, 7% (n=2) received dietitian referrals.

Implications & Conclusions: Overall, both the RAI-HC and its current implementation do not

seem effective in identifying nutrition risk or generating dietitian referrals for those at risk. These

findings suggest a need for better screening of HCC clients in identifying nutrition risk, and better

generation of nutrition referrals to HCC dietitians, to more effectively address the nutrition needs

of the HCC population.


OBSERVATION OF MEALTIME ENVIRONMENTS IN NORTHERN HEALTH LONG-TERM CARE FACILITIES: DIETETIC INTERN RESEARCH PROJECT K BOGH

1, L BURTON1, E BRANCO

2, L KRAITBERG3, S FINCH

3, H TUFTS1


2NORTHERN HEALTH, CLINICAL NUTRITION

3NORTHERN HEALTH, REGIONAL DIET OFFICE

NORTHERN HEALTH CORE SITE Background: Globally, malnutrition affects 12–54% of residents in long-term care (LTC). A

primary cause of malnutrition in LTC is poor dietary intake. The mealtime environment (i.e., social

interactions, provision of eating assistance, and physical environment) can affect residents’

intake, but little is known about the mealtime environment in Northern Health LTC homes.

Objective: To observe the mealtime environment in two Northern Health LTC homes to identify

current strengths and areas for improvement.

Methods: A naturalistic observational study was conducted at two LTC homes in northern British

Columbia. In one dining room at each facility (representing 18% or 65% of the facility’s residents),

two trained raters assessed mealtime practices in three domains (social interactions, provision of

eating assistance, and physical environment) using a modified version of the CHOICE+ Mealtime

Practices Checklist. This checklist includes mealtime practices associated with person-centered

care. Nine meals were observed at each facility. For each mealtime practice, raters recorded the

proportion of meals at which the practice was observed. Inter-rater agreement was assessed by

calculating percent absolute agreement.

Results: All raters observed the following practices during at least 67% of meals: 1) staff

addressed residents respectfully, 2) food was served in a timely manner, 3) staff supported

residents to dine at their own pace, and 4) residents were included in social conversations. The

least frequently observed practices (fewer than 20% of meals) included 1) asking residents if they

wanted a clothing protector, 2) offering residents their choice of beverage or first course, 3)

delivering medications before meals, and 4) playing music in the dining room.

Implications & Conclusions: Many mealtime practices on the CHOICE+ checklist were

regularly observed at both LTC homes. Potential areas for improvement were also identified.

These results will inform quality improvement initiatives to enhance the mealtime environment in

these two facilities.


A DESCRIPTION OF WEIGHT TRENDS AND METABOLIC SYNDROME RISK FACTORS IN THE ALDER TERTIARY MENTAL HEALTH UNIT POPULATION

N KONTOGIANNIS1, M YELLAND-DESYLVA

1, H TUFTS1, K VOGT

1, C ADAIR2

F JOHNSON2, JC KOH

2, C KWAN2


2PROVIDENCE HEALTH CARE, CLINICAL NUTRITION

PROVIDENCE HEALTH CARE CORE SITE

Objective: To determine the prevalence of risk factors (RFs) for metabolic syndrome (MetS) and weight trends in clients admitted at Alder Tertiary Mental Health Unit at St. Vincent’s: Langara residential facility.

Methods: A retrospective chart review was completed for all clients (n=50) admitted from January 1, 2011- October 31, 2016 at Alder Tertiary Mental Health Unit. Data was collected on psychiatric diagnosis, demographics, anthropometrics, lipid profile, and the presence or absence of hypertension and diabetes mellitus and their corresponding medications. No data points were collected past October 31, 2016. Descriptive statistics were used for analysis.

Results: The majority of the study subjects were aged 40 years or older (n=47, 90%) and male (n=40, 80%). Brain injury was the most common admitting diagnosis and all clients were on a form of antipsychotic medication. There was no universal weight trend among the study population over the course of the study time frame. Average initial and final BMI for the study population varied only slightly from 24.1kg/m2 to 24.77kg/m2 during the study time frame. Low HDL and elevated TG were the most prevalent RFs, accounting for 80% (n=40) and 54% (n=27) of the study population, respectively. 38% (n=19) of the study population met the criteria for MetS, defined as having 3 or more RFs.

Implications & Conclusion: MetS is prevalent in Canada, resulting in significant strain on affected individuals and the healthcare system. There are currently few studies investigating the prevalence of MetS and specific RFs in the tertiary mental health setting and a knowledge gap remains. Study outcomes may help guide nutrition interventions to enhance patient care in this unique population. Interventions directed at combating MetS risk in the population at Alder Tertiary Mental Health Unit may provide greatest benefit if they target improving client blood lipid profiles.


KNOWLEDGE AND ATTITUDES OF PHYSICIANS AND NURSES TOWARD ENTERAL FEEDING ON A GENERAL MEDICINE WARD

H LAU1, L POLZER

1, M STEELE1, V LEWIS

2, J THORNHILL2, F JOHNSON

2, JC KOH2

H TUFTS1


2PROVIDENCE HEALTH CARE, BRITISH COLUMBIA

PROVIDENCE HEALTH CARE CORE SITE Objective: To describe the attitudes and knowledge of physicians and nurses (PhaN) toward enteral feeding on the general medicine wards at an acute care hospital. Methods: An original survey was developed to assess attitudes and knowledge of PhaN toward enteral feeding on the general medicine wards at St. Paul’s Hospital in Vancouver, BC. The 15-item questionnaire was developed by dietitians with survey design experience, and was subject to a multi-step review process, including review by dietitians and a research statistician with a background in behavioral and attitudinal survey design, followed by a pilot test. Participants were recruited through convenience sampling. Paper and online questionnaires were self-administered over a three week period. Responses were analyzed using descriptive statistics. Results: Seventy-nine surveys were returned (28% response) and 76 analyzed. Respondents included nurses (71%, n=54/76), physicians and residents (18%, n=14/76), or medical/nursing students (11%, n=8/76). Eighty-two percent (n=62/73) of respondents “strongly agreed” or “agreed” with three or more statements reflecting a positive attitude toward enteral feeding. Three percent (n=2/76) correctly answered five or more questions out of six on the knowledge component of the survey. Implications & Conclusion: This study contributes to the body of evidence on PhaN attitudes toward, and knowledge of enteral feeding and, its findings will be used to develop site-specific education for PhaN to improve delivery of nutrition support. The results suggest PhaN on the general medicine wards at St. Paul’s Hospital have a positive attitude toward enteral feeding, but limited knowledge of its basic principles. These findings are consistent with other studies that describe PhaN attitude toward, and knowledge of enteral feeding, although they are not generalizable. Further research is needed to determine how knowledge and attitude impact behaviour specific to enteral feeding.


A DESCRIPTION OF ONCOLOGY PATIENTS WHO ARE AT RISK FOR MALNUTRITION UPON ADMISSION AT THE BC CANCER AGENCY

S MAHERALI1, C POLLOCK

1, H TUFTS1, R LEVY-MILNE

2, S SEKHON2


2PROVINCIAL HEALTH SERVICES AUTHORITY, BRITISH COLUMBIA CANCER AGENCY, VANCOUVER CENTRE

PROVINCIAL HEALTH SERVICES AUTHORITY Objectives: The BC Cancer Agency (BCCA) uses a Nutrition Screening Tool (NST) to quantify malnutrition risk. Patients who score 3-5 on the NST are triaged and contacted by a Registered Dietitian (RD), as per BCCA nutrition intervention framework. NST3 indicates moderate malnutrition risk and is determined using two parameters: weight loss and appetite change. This study describes the NST3 group and reviews current nutrition practices of these patients. Results will help improve triaging and referrals in the Oncology Nutrition department across all BCCA centers and help RDs better prioritize patients at nutritional risk. Methods: A retrospective chart review was conducted of patients scoring an NST3 between September 1 to October 31, 2016 from 5 BCCA centers. Information was obtained from NST forms and electronic medical records (CAIS). Data was entered into a secure Excel spreadsheet and analyzed using frequency distribution. Results: Of the total NST3 patients (n=145), 77 (53%) scored an NST3 through the combination of 14-23lbs weight loss and appetite change, 23 (16%) with 24-33lbs weight loss, and 45 (31%) with an unsure amount of weight loss and appetite change. The group with 24-33lbs weight loss had the highest proportion of individuals seeing a BCCA RD (39%), followed by 30% of the 14-23lbs and appetite group, and 20% of the unsure weight loss and appetite group. Implications & Conclusions: Using the combination in which patients score an NST3 and additional NST questions may be valuable in better predicting nutrition risk and help prioritize the NST3 population. Additional research into the unsure/appetite group may provide greater insight into triaging procedures and may help improve dietetic practice in regards to efficiency and patient care. Research findings will inform the nutrition intervention framework used to triage patients within the cancer care population. It is vital to ensure all patients who require nutrition intervention are receiving timely and appropriate nutrition care in a standardized and efficient way—this research helps to inform this balance.


HOMEMADE BLENDERIZED TUBE FEEDING: DIETITIANS SURVEYED

K BELL1, C BELLAMY

1, J LAU1, K YEE

1, C KARIYA2, H TUFTS

1


2VANCOUVER COASTAL HEALTH, CLINICAL NUTRITION, VANCOUVER

VANCOUVER COASTAL HEALTH Background: Homemade blenderized tube feeding (HBTF) appears to be gaining popularity. Studies have not explored if dietitians perceive themselves as competent to manage the nutrition of patients who choose BTF. Objective: The purpose of this cross-sectional survey study was to describe dietitians’ perspectives and perceived competence on the topic of HBTF. Methods: An anonymous web-based questionnaire was emailed to all 715 dietitians registered with the College of Dietitians of British Columbia holding the authority to design, compound, or dispense enteral nutrition. Results: There were 221 completed questionnaires. Respondents varied with regards to practice settings and patient age ranges, with the majority working primarily in acute care and with adults. Only 27% of respondents felt knowledgeable about HBTF and 25% felt they could confidently manage patients using HBTF. Less than half felt they had the expertise to design HBTF, administer HBTF, or teach patients to administer HBTF (29%, 15%, 24%). Comparing commercial formulas to HBTF, many respondents felt HBTF provides equal or superior nutritional benefit (33%, 37%), is more cost effective (46%) and more effective for managing food allergies (40%). However, a considerable number felt HBTF has higher risk for tube blockages and bacterial contamination (76%, 84%). Respondents’ HBTF education was mostly derived from informal sources (self-directed learning 49%, learning from colleagues 33%, learning from patients 32%), while 27% reported having no education of any kind. Most respondents (64%) support the use of HBTF and 89% reported a desire to learn more about HBTF. Implications & Conclusions: Dietitians have limited confidence in managing patients who choose to use HBTF. They perceive themselves to lack knowledge and expertise on the practice. Formal education on HBTF is uncommon among dietitians, however support for the use of HBTF is prevalent. In order for dietitians to confidently and capably support patients using HBTF, education is essential.


SUITABILITY OF PREMIXED PARENTERAL NUTRITION SOLUTIONS TO MEET NUTRITIONAL NEEDS OF HOSPITALIZED SURGICAL PATIENTS AT VANCOUVER GENERAL HOSPITAL

E HUANG1, A LAM

1, K LANDRIGAN1, J MAH

1, T CIVIDIN2, M RADHAKRISHAN

2 1UBC DIETETICS PROGRAM, VANCOUVER

2VANCOUVER COASTAL HEALTH, CLINICAL NUTRITION DEPARTMENT

VANCOUVER COASTAL HEALTH Background: The American Society for Parenteral and Enteral Nutrition (ASPEN) recommends implementing standardized processes for PN management to promote consistent practice among clinicians and health care facilities. One of the recommendations includes the use of premixed PN solutions, which were introduced to the Canadian market in 2011. Premixed PN may lead to more consistent practice among clinicians, reduced dietitian and pharmacy workload, and decreased PN order writing and compounding errors, ultimately leading to improved patient safety. Objective: To determine if commercially premixed PN solutions could be substituted for in-house compounded PN to meet the macronutrient needs of adult general surgery patients at VGH. Methods: A retrospective chart review was conducted on 51 surgical patients receiving PN at VGH from January 1 to June 30, 2016. Demographic data, diagnosis, indication for PN, and PN macronutrient prescription orders were collected. Macronutrient prescriptions were compared against 8 premixed PN solutions available in Canada: SmofKabiven 1.0, 1.5, 2.0, 2.5; Olimel 4.7%E (1000 mL); and Olimel 5.7%E (1000 mL, 1500 mL, 2000 mL). A solution was considered to be acceptable if 2 of the 3 macronutrients were within ±20% of the PN order. Results: There were a total of 209 PN orders from 51 patients (45% female, 55% male; average BMI 22.3; average age 58 years). Diagnoses included cancer (35%), fistula (14%), small bowel obstruction (12%), Crohn’s disease (6%), perforated transverse colon (4%), pancreatic disease (2%), anastomotic leak (0.4%), diverticulitis (0.02%), gastrointestinal dysmotility (0.02%), and hepatic disease (0.02%). The indications for PN were impaired nutrient absorption (43%), disordered motility (19.6%), malnutrition (11.8%), NPO (9.8%), inability to achieve/maintain EN (5.9%), chemotherapy (3.9%), and unknown (3.9%). 196/209 (93.8%) of PN orders could have been met by at least one premixed PN solution, 190/209 (90.9%) orders could have been met by at least one Olimel product, 182/209 (87%) orders could have been met by at least one SmofKabiven product. Implications & Conclusions: Premixed PN solutions appear to be an acceptable substitution for in-house compounded PN to meet macronutrient needs of adult general surgery patients at VGH. In particular, the Olimel product line may be more appropriate because it offers lower amount of carbohydrates making it appropriate for a wider range of patients at risk for refeeding syndrome. Further research is needed to determine the feasibility and patient safety implications of using premixed PN solutions at VGH.

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DIETETIC RESEARCH ABSTRACTSdietetics-landfood.sites.olt.ubc.ca/files/2015/02/Research-Abstract... · abstracts found here, interns prepare a final paper and present their findings