Philippine Society for Parenteral and Enteral Nutrition

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Program Description

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Competencies learned

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Activities for the year

CLINICAL NUTRITION FELLOWSHIP TRAINING PROGRAM

Mission/Vision | Back

  • To establish a fellowship training program in nutrition support which aims:
    • To produce fellows in nutrition support who will practice nutrition support management whose standards fulfill the highest level of competence required by the JCAHO or similar care standards evaluation groups.
    • To establish and improve on “best practice” of nutrition support in the hospital set up as delineated by the JCAHO/JCIA and similar standards delineating organizations and systems.
  • To establish in St. Luke’s Medical Center the vehicle that will enable mentor and trainees:
    • To help the Nutrition Committee establish guidelines in all aspects of nutritional support.
    • To monitor and improve the standards of practice in nutritional support in the hospital set up.
    • To educate and update the whole hospital staff on correct methods and ways as well as updates in nutrition management.
    • To do research projects in nutrition support and to make this discipline an integral part of the practice and training of every person involved in nutritional support in the hospital
    • To establishes values and standards in the field of nutritional support and to promote excellence in nutritional management and delivery.
  • To establish and maintain a center of clinical nutrition which will
    • Practice, maintain, and coordinate all aspects of nutritional support in every institute, department, and center in St. Luke's Medical Center.
    • Help in establishment of nutrition support groups, nutrition management programs, and clinical nutrition education and/or training programs or practitioners in the Philippines and the Asia-Pacific region.

Program Description (Back)

  1. Two year program for a Diplomate in Clinical Nutrition title
  2. Qualifications and/or requirements for those who are eligible to be accepted in the program:
    1. Physician
    2. Graduated as Doctor of Medicine from a Philippine certified school in medicine and licensed to practice in their specific profession.
  3. Program Subject Matter:
    1. Nutritional and Metabolic Consequences of Critical Illness
      1. Sepsis
      2. Surgical complications
      3. Trauma, Burns
      4. Geriatric
    2. Malnutrition Secondary to Systemic Disease
      1. Malabsorption syndrome             
      2. Chronic liver disease                   
      3. Chronic renal disease             
      4. Chronic lung disease                
      5. Pancreatic insufficiency
      6. Cancer cachexia
      7. Chronic infections
      8. Chronic illnesses
    3. Primary Malnutrition/Starvation 
    4. Protein Energy Malnutrition/Nutritional Anemias/ Chronic Alcoholism
    5. Indications; Principles and Techniques of Nutritional Support
      1. Enteral Nutrition
      2. Parenteral Nutrition      
    6. In the Hospital and Home Setting
  4. Program Requirements:
    1. Two year (24 months) of mentoral and clinical experience and formal instructions
      1. In patient setting: 60% - 70%
      2. Out patient setting: 30% - 40%
  5. Program Facilities and Equipment:
    1. Inpatient and Ambulatory Care
    2. Laboratory Resources
    3. Interdisciplinary Nutrition Support 
    4. Indirect Calorimetry Equipment
    5. Body Composition – Assessment Facility
    6. Dietary Service
Program Content (Back)
  1. Clinical Experience
    • Observation and Management of New and Follow Up Inpatients and    Outpatients, Both Sexes, Different Age groups, Wide Variety
    • Physician supervision
    • Interdisciplinary Setting: physician, nurse, dietitian, pharmacist.
    • Consultation/referral service to other MDs/units in the Hospital
    • Case Conference
  2. Formal Instruction
    • Evaluation/ Nutritional Management/ Prevention of:
      1. Stress states
      2. Hypometabolic/Starvation States
      3. Refeeding Syndrome
    • Drug Nutrient Interactions
    • Fluid and Electrolyte Management
    • Interpretation of Laboratory Values
    • Nutritional Access Device and its Complication
  3. Technical Skills
    • Indications/Contraindications/Complications/Limitations
    • Diagnostic and Therapeutic Techniques
      1. Nutritional assessment (History/PE/Laboratories)
      2. Body Compositions and Energy Expenditure Assessment
      3. Dietary Counseling
      4. Feeding Devices
      5. Enteral/ Parenteral Nutrition in both Inpatient and Outpatient  Setting
  4. Evaluation Procedure:
    • Written Examination                              
    • Lectures
    • Oral Examination                                   
    • Case Presentations
    Responsibilities and Overall accountability of the activities of all the members of the clinical nutrition training program – the head, training officer, and all active staff physicians of the clinical nutrition training program must document in any activity, be it in prescription order writing or notes in the medical record, their involvement in the form of placement of their names before the fellow after each activity as in prescription writing, chart orders, medical record notes). No fellow in training physician, dietitian, nurse, or pharmacist is allowed to place only their names in any order or note in order to avoid loss of accountability.

Competencies Learned (Back)

Individual Competencies – by the end of the training program each fellow will now be able to learn and practice the following:

  • Fluid, Energy Nutrient Requirement
    • Measures of Energy Intake
    • Metabolism/Absorption/Utilization of proteins
    • Metabolism/Absorption/Utilization of Carbohydrates
    • Requirements for Macro/Micronutrients
    • Nutritional requirements in early life
      • Counsel regarding infant and child feeding
    • Nutritional recommendations for adolescents
    • Nutritional status and requirements in pregnancy and lactation
    • Identification of nutrient deficiencies and toxicities
    • Criteria of Adequate Diet including RDA
    • Major Minerals: chemical properties; absorption, transport, metabolism, functions
  • Food Sources and Requirements
    • Dietary sources of macro and micronutrients
      • Vitamins – chemical properties; absorption, transport, metabolism, functions
      • Identification of nutrient deficiencies and toxicities
      • Diagnosis of vitamin deficiencies and excesses
    • Trace elements: mechanical properties; absorption, transport, metabolism and functions
      • Diagnosis of mineral and trace element deficiencies and excesses
  • Factors Affecting Body Weight/ Composition/Energy Balance
    • PE and Anthropometry
    • Laboratory Data
    • Biochemical Data
    • Nitrogen balance
    • Calorimetry
  • GI Physiology
    • Physiology of hunger, satiety, and eating behavior
    • Gastrointestinal Disorders
    • Malabsorption/Inflammatory/Gastrointestinal Processes
  • Metabolism, absorption, and utilization of fiber
  • Nutrition and Aging interactions
  • Growth and development
  • Lipid Absorption and Transport
    • Factors affecting circulating lipid concentrations
    • Lipid classification and properties
  • Hormonal Control of Nutrient Metabolism
  • Indications for Special Substrates
  • Diagnosis of Protein Energy Malnutrition
    • Medical History
    • Diet History
  • Enteral Nutrition – Indications and Contraindications
    • Calculation of Nutrient Composition of Formulas
    • Physiologic Complications
    • Metabolic Complications
    • Mechanical Complications
  • Parenteral Nutrition – Indications and Contraindications
    • Calculation of Nutrient Composition of Formulas
    • Metabolic Complications
    • Septic Complications
    • Mechanical complications
  • Home parenteral nutrition – initiation, management, discontinuance
  • Comparison between parenteral and enteral nutrition
  • Specific conditions:
    • Critical Illness
    • Wasting Diseases
    • Endocrine Conditions
    • Cardiopulmonary Illnesses
    • Renal Insufficiency and Failure
    • Initiation and withdrawal of nutrition support
    • Obesity
    • Eating Disorders
    • Transplantation
  • Drug nutrient interaction
  • Alternative Nutrition Therapies and Supplements
  • Cultural and ethnic influences on nutrition
  • Informed consent regarding nutritional support

(Reference: Interdisciplinary nutrition support core competencies. A.S.P.E.N. Board of Directors NCP 1999; 14: 331-3)

Interdisciplinary Nutrition Support Core Competencies – by the end of the program the fellow will now be able to perform the following as part of an interdisciplinary nutrition support team or group: (Back)

  • Assesses nutritional/metabolic status using appropriate age and population-specific screening and assessment tools.
  • Determines nutritional/metabolic requirements based on findings of subjective and objective nutrition assessment.
  • Establishes interdisciplinary nutrition care plan including goals of therapy, metabolic needs, route of nutrition support, discharge plan, patient education and/or home training.
  • Selects the appropriate formula/formulation and route for administration of specialized nutrition support based on patient s disease process and compatibility with route of access.
  • Participates in the management of complications related to nutrition support therapy.
  • Interprets laboratory data in conjunction with ongoing monitoring of clinical status; and recommends/prescribes appropriate management/treatment for abnormalities.
  • Identifies nutrient-nutrient, drug-nutrient interactions.
  • Designs/recommends patient-specific feeding formulation/prescription
  • Quantifies actual nutrient intake.
  • Disseminates accurate nutrition information to colleagues and patients and serves as preceptor for nutrition training.
  • Performs Quality Improvement activities using an evidence-based decision making process.
  • Provides leadership in promoting quality nutrition support practice.
  • Engages in self-assessment and continuing professional education.
  • Critically evaluates the design of research studies and uses research findings in practice.
  • Designs and/or conducts basic science or clinical research as appropriate to the practice setting and position.
  • Generates and analyzes data related to cost when evaluating nutrition support products, equipment, supplies, techniques, and services.
  • Participates in and supports decisions related to termination of therapy.
  • Undertakes decisions and actions in an ethical manner.
  • Evaluates outcomes of nutrition intervention.
  • Teaches/educates patients and caregivers on modality of nutrition support, delivery systems, care of catheter and access site, and other content appropriate to the nutrition care plan and the patient s learning needs.

(Reference: Interdisciplinary nutrition support core competencies. A.S.P.E.N. Board of Directors NCP 1999; 14: 331-3)

Practice-Based Core Competencies – at the end of the training program, the following practice competencies are learned and accomplished: (Back)

  • Physician and Nurse - Demonstrates proficiency in the establishment of venous access.
  • Physician, Nurse, and Dietitian - Demonstrates proficiency with feeding tube insertion.
  • Physician, Nurse, Dietitian, Pharmacist - Obtains/writes prescriptions for nutrition support therapies.
  • Physician, Nurse, Dietitian, and Pharmacist - Monitors drug-drug, drug-disease interactions and related pharmacokinetic parameters.
  • Physician, Nurse, Dietitian, Pharmacist - Prepares or supervises preparation of enteral feeding formulations.
  • Pharmacist - Demonstrates proficiency in compounding parenteral nutrition formulations.
  • Physician, Nurse, Dietitian, Pharmacist - Manages enteral and parenteral feeding access devices and related delivery systems.
  • Physician, Nurse, Dietitian - Demonstrates proficiency in care of access site.

(Reference: Interdisciplinary nutrition support core competencies. A.S.P.E.N. Board of Directors NCP 1999; 14: 331-3)

Daily Activities (Back)

  • Morning:
    • Update Records:
    • Get List of New Admissions and Discharged Patients
    • Update the "Access Based Nutrition Database Program"
      • Surveillance:
      • List of All Malnourished Patients
  • Morning to Afternoon:
    • Discuss New Admissions
    • Identifies all the malnourished patients
    • Make Nutrition Care Plans for the Patients
    • Notify the Attending MD including the Recommendations
  • Focus:
    • Discuss all Critical Care Patients
    • Review their status
  • Checks the completeness of the forms and the data
  • Updates the Nutrition Care Plan, their Implementation, and discuss the Monitoring
  • Evaluate each patient
  • Discuss the rest of the malnourished patients
    • Review their status
    • Report by the Person in charge of all specific units
    • Update on the Nutrition Implementation
  • These are the Points of Discussion:
    • History and P.E.
    • SGA
    • Laboratory Results
    • Problems
      • Main Problem
      • Nutritional Problem
      • Pathophysiology of the Disease
      • Rationale of Treatment
        • What has been done
        • Any Recommendation
        • Nutritional Management
        • Any Updates on the Current Mode of Therapy

Activities for the Whole Year (Back)

  • Daily Nutrition Rounds
  • End of the Week Meeting
    Summary of the week's work
    Special Case Discussion
    Lecture
    End of the Month Meeting
    Monthly Grand Rounds
    Monthly Examination
    Conferences with the Different Departments
    Post-Graduate Course - once a year
    Research Paper Presentation
  • Presentation at the Annual Convention of the Philippine Society of Parenteral and Enteral Nutritio
 

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