Nutrition process improvements for adult inpatients with inborn errors of metabolism using the i-PARIHS framework

Clare Williams, Barbara S. van der Meij, Janelle Nisbet, Jim Mcgill, Shelley A. Wilkinson

Research output: Contribution to journalArticleResearchpeer-review

1 Citation (Scopus)

Abstract

Aim: This project aimed to implement consensus recommendations and innovations that improve dietetic services to promote timely referral to optimise nutritional management for adult inpatients with inborn errors of metabolism (IEM). Methods: The i-PARIHS framework was used to identify service gaps, implement innovations and evaluate the innovations within this single-site study. The constructs of this framework are: (i) review of the evidence; (ii) recognising patients and staff knowledge and attitudes; (iii) acknowledging the local context; and (iv) the facilitators role. This included a literature review and metabolic centre service comparisons to investigate dietetic referral and foodservice processes to inform the innovation. A 12-month chart audit (6 months retrospective and prospective of implemented innovation, respectively) to evaluate newly established dietetic referral and IEM nutrition provision procedures was also completed. Results: The innovations implemented encompassed a clinical alert triggering urgent referral, nutrition sick day plans and metabolic diet and formula prescription via an ‘alert’ tab in electronic records. Eleven metabolic protein-restricted diets and nine formula recipes were introduced. Prior to the innovations, only 53% (n = 19/36) of inpatients with IEM were assessed by the dietitian and received appropriate nutrition within 24 hours. Following implementation of the innovations, 100% (n = 11/11) of inpatients with IEM received timely dietetic assessment and therapeutic nutrition. Conclusions: Implementation of innovations developed using the i-PARIHS framework is effective in timely notification of the metabolic dietitian of referrals. This ensures optimal nutritional management during admissions which is required in this group of high-risk patients.

Original languageEnglish
Pages (from-to)141-149
Number of pages9
JournalNutrition and Dietetics
Volume76
Issue number2
Early online date7 Mar 2019
DOIs
Publication statusPublished - Apr 2019

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Nutritional Physiological Phenomena
Inborn Errors Metabolism
Dietetics
Inpatients
Referral and Consultation
Nutritionists
Attitude of Health Personnel
Formulated Food
Protein-Restricted Diet
Sick Leave
Nutrition Assessment
Prescriptions
Consensus

Cite this

Williams, Clare ; van der Meij, Barbara S. ; Nisbet, Janelle ; Mcgill, Jim ; Wilkinson, Shelley A. / Nutrition process improvements for adult inpatients with inborn errors of metabolism using the i-PARIHS framework. In: Nutrition and Dietetics. 2019 ; Vol. 76, No. 2. pp. 141-149.
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Nutrition process improvements for adult inpatients with inborn errors of metabolism using the i-PARIHS framework. / Williams, Clare; van der Meij, Barbara S.; Nisbet, Janelle; Mcgill, Jim; Wilkinson, Shelley A.

In: Nutrition and Dietetics, Vol. 76, No. 2, 04.2019, p. 141-149.

Research output: Contribution to journalArticleResearchpeer-review

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