2.The Role of Registered Dietitians in Nutrition Support Team
Division of Nutrition, Gengendo Kimitsu Hospital
By the revision of Japanese health insurance system in 2010, addition of the nutrition support team fee was newly established. This is because the activities of the nutrition support team (NST) up to now are highly valued. And this is an indication of expectation of the future.
The NST activities in hospitals will be more and more important. It is inevitable that a registered dietitian who is a professional of clinical nutrition plays a central role in a team. It is needless to say that registered dietitians should be excellent in insight of and have experience of clinical nutrition. Additionally, management skill is tested from now on. In this paper, the author describes the role of registered dietitians in the NST of our hospital, centering on the clinical actions.
The role of registered dietitians in the NST of our hospital
Currently, the activities of the NST are almost standardized. Based on this, a role of each staff is clearly established. Also in our hospital, activities performed in accordance with the standardized activities.
he role of registered dietitians in clinical activities includes screening of cases, evaluation of nutrition, nutrition planning, nutrition monitoring, and re-planning. The registered dietitian not only calculates nutrient requirements but also deliberates the selection and the flow rate of transfusion, medicine, and enteral formulas, proposal of feeding tubes, and access routes. Nutritional management is affected by the quality of all kinds of treatments such as water and electrolyte, medicine, nursing care, and device, etc. So, only proposal of calculation of nutrient requirements fall short of nutrition management. Therefore, it is required to perform nutrition planning and monitoring by gathering information for making a decision from various fields. After planning nutrition, information of changes in aspiration, circulation, metabolism, and digestive organs is gathered from X-ray and ECG as well as physical findings and blood & urinary examination. If required, transfusion, medicine, and examination are also referred.
Various treatments are involved in nutrition management. We understand and judge entire treatment. After that, we summarize opinions of staffs to provide appropriate nutrition care.
The role of registered dietitians in team management
By the new establishment of the NST addition, many registered dietitians join the project full-time. From now on, substantive management is entrusted to registered dietitians. In our hospital, staffs other than the registered dietitians do not participate in the NST with enough knowledge and motivation. Sometimes, they find difficulty in the NST management.
In a team, members should clarify roles and responsibilities under the common philosophy and share knowledge, ability, experience, and time. They should accomplish the goal by the synergy effect. If management lacks a plan, the management depends on the effort of individuals. Effective team management does not last long. It is necessary to learn team management to extract power of a team.
NST has been common all over Japan for 10 years. By the new establishment of NST addition, expectations and roles of registered dietitians will get larger in the future. They should have the conscious and take actions not to fall short of expectations.