Nutrition support teams: Institution, evolution, and innovation

Abstract

The historical institution, evolution, and innovations of nutrition support teams (NSTs) over the past six decades are presented. Focused aspects of the transition to transdisciplinary and patient‐centered care, NST membership, leadership, and the future of NSTs are further discussed. NSTs were instituted to address the need for the safe implementation and management of parenteral nutrition, developed in the late 1960s, which requires the expertise of individuals working collaboratively in a multidisciplinary fashion. In 1976, the American Society for Parenteral and Enteral Nutrition (ASPEN) was established using the multidisciplinary model. In 1983, the United States established the inpatient prospective payment system with associated diagnosis‐related groupings, which altered the provision of nutrition support in hospitals with funded NSTs. The number of funded NSTs has waxed and waned since; yet hospitals and healthcare have adapted, as additional education and experience grew, primarily through ASPEN's efforts. Nutrition support was not administered in some instances by the “core of four” (physician, nurse, dietitian, pharmacist). The functions may be carried out by a member of the core of four not associated with the parent discipline, in accordance with licensure/privileging. This cross‐functioning has evolved into the adaptation of the concept of transdisciplinarity, emphasizing function over form, supported and enhanced by “top‐of‐license” practice. In some institutions, nutrition support has been incorporated into other healthcare teams. Future innovations will assist NSTs in providing the right nutrition support for the right patient in the right way at the right time, recognizing that nutrition care is a human right.

Advocating for a patient‐ and family centered care approach to management of short bowel syndrome

“…11 The reality is that nutrition support teams have greatly evolved over the past several decades; in the US context, this is primarily due to changes in funding. 15 Functions conducted by these core team members have adapted over time by transitioning responsibilities among team members that were traditionally discipline specific. Nutrition support functions may also be delegated to other healthcare teams within an institution or outside the institution, such as with the home infusion provider.…”

“…Such teams should ideally include a gastroenterologist, surgeon, advanced practitioner (nurse practitioner and/or physician assistant), nurse, dietitian, and pharmacist 11 . The reality is that nutrition support teams have greatly evolved over the past several decades; in the US context, this is primarily due to changes in funding 15 . Functions conducted by these core team members have adapted over time by transitioning responsibilities among team members that were traditionally discipline specific.…”

Clinical pharmacists in nutrition support: Don't throw the baby out with the bath water!

“…It should be noted that the discipline of clinical pharmacy had not yet evolved during that time. The first article that I am aware of that described the role of the team members, including the clinical pharmacist but not discussed by Barrocas et al, 1 was from the University of Tennessee and published in 1975. 2 They indicated that the "TPN team" was formed in July of 1973, which consisted of a physician, pharmacist, and nurse.…”

Response to “Clinical pharmacists in nutrition support: Don't throw the baby out with the bath water!”

“…Dr Dickerson's erudite Letter to the Editor is a welcomed extension to our article. 1 Although the initial author group included two pharmacists, unanticipated obligations prevented their participation in the required timeline.…”

“…The described timeline regarding the University of Tennessee pharmacy group with its many recognition awards as a team and as individuals is a welcome addition to the list of NSTs cited in our article. 1 On a personal note, we, at Methodist Hospital in New Orleans, had the privilege of hosting another excellent and dedicated NST from Memphis, Tennessee. Among the many contributions of clinical pharmacists in American Society for Parenteral and Enteral Nutrition (ASPEN)-related activities were the sessions entitled "Clinical Pearls" adapted from them and coordinated by our NST pharmacist Dr Charles Jastram, which were quite popular and well attended.…”