Nutrition Support Blog: Choosing Wisely Campaign for Nutrition
July 2, 2012
I have been considering the role for nutrition support clinicians in the campaign. It is evident that the goals of the campaign, to promote responsible use of health care resources and to minimize unnecessary tests, are very consistent with the practices of most nutrition support clinicians (see my previous blog for more general details on the campaign).
We circulated information about the Choosing Wisely campaign among our own staff here at UVAHS in order to elicit feedback about additional ways that dietitians and other nutrition support clinicians can contribute to reducing unnecessary health care costs. Our expanded list of items to consider as part of the responsible use of medical/nutrition resources includes:
- Avoid parenteral nutrition when enteral nutrition is possible.
- Avoid parenteral nutrition in well nourished patients before 7-10 days.
- Avoid specialty enteral products that do not have adequate data for improved patient outcomes.
- Avoid nutraceuticals and high-dose nutrient supplements that do not have adequate data for improved patient outcomes.
- Do not order albumin, prealbumin (with or without C-reactive protein) or transferrin as markers of nutrition status in hospitalized patients.
- Avoid ordering labs that are affected strongly by an acute phase response to the point that they are unreliable while patients are in the ICU or acute care setting such as vitamin A, zinc, ferritin, iron, and even 25-OH vitamin D.
- Avoid ordering “refeeding labs” more than daily, except in occasional cases of patients with severe malnutrition at extreme risk of symptomatic refeeding.
- Do not order a full lipid panel for patients receiving IV lipid emulsions or propofol, when only a serum triglyceride is necessary.
It is true that the cost of nutrition interventions or formulas pale in comparison to the overall cost of medical interventions or an ICU stay. However, it is exactly that type of thinking that got us into this mess in the first place. It is long past due for the entire medical community to join forces and be responsible with all of the limited resources of health care. It is a very sobering experience to suddenly find yourself without multivitamins or acetate for parenteral nutrition. However, the type of shortages we have experienced thus far may be insignificant to what could happen one day should we continue along the same healthcare path that we have been on. Regardless of what changes may happen to state or federal healthcare regulations – there is no substitute for personal responsibility of clinicians everywhere...this IS "our watch."
“We can't solve problems by using the same kind of thinking we used when we created them.”
- Albert Einstein