The Hospital Nutrition Steering Committee

Brings together senior managers from many disciplines including nursing, catering, dietetics, pharmacy, medicine & surgery. It may appropriately be chaired by the Head Nurse or a senior figure within the hospital who can provide natural links with Governance and the Board. It may benefit from having sub-committees – for example, Research and Development, Screening, Specialist Services, Catering.

Its remit is across the whole hospital or institution. It:

  1. Oversees and advises the hospital on all aspects of nutrition, including screening and assessment, catering and food, supplements, enteral and parenteral nutrition – for in-patients and out-patients.
  2. Scrutinises, develops and co-ordinates hospital nutritional policy in response to  external and internal drivers  through research and audit.
  3. Agrees standards for screening, assessment and monitoring;  food provision and nutritional support
  4. Co-ordinates delivery of excellent nutritional support in all units, specialist or general.
  5. Co-ordinates and monitors appropriate education and training programmes for all staff.
  6. Liaises with specialist units and if necessary encourages, supports and  develops specific needs for nutritional care delivery within them
  7. Supports at least one multi-professional  nutrition support team which includes at least one  nutrition nurse specialist
  8. Oversees the coordinated procurement of supplies relevant to nutrition
  9. Oversees management of food for staff
  10. Advises on provision of commercial food outlets on hospital premises
  11. Is answerable through a governance committee to the hospital board

Diagram showing areas of responsibilities for the Hospital Nutrition Steering Committee.

Nutrition Steering Committee Diagram

Nutrition Support Team(s) (NST)

Is multi-professional and should include (at least) doctors, nutrition nurse specialist(s), dietitian(s) and pharmacist(s). It should be a role model for multi-professional working. It brings together nutritional experts from medicine/surgery, nursing, dietetics and pharmacy who can co-ordinate the contributions of each of these specialties into coherent nutritional support. It manifestly cannot do all the ward delivery of nutritional care itself, but serves to organise it and enhance it. It becomes particularly involved when there are problems requiring complex artificial nutritional support, especially parenteral nutrition. It may have a specialist role in supporting Home Parenteral Nutrition. The dietitian and pharmacist need to be senior staff and will have a supervisory role within their departments. The team’s operational focus is the safe provision of artificial nutrition but it also has a wider educational remit. It:

  1. Maintains itself as the  principal  source of evidence-based information about nutritional assessment and support
  2. Liaises closely with Nutrition Steering Committee (see above)
  3. Fosters and provides education, training and research in nutritional screening, assessment, monitoring and nutritional support,  for  nurses, medical students, doctors, dietitians, pharmacists and  managers.
  4. Develops and audits practical standards of care and organises approaches to nutritional screening, assessment, monitoring and artificial nutrition (eg catheter sepsis rates).
  5. Is a focus for a multi-professional approach to artificial nutrition and provides co-ordinated medical, pharmaceutical, nursing and dietetic advice on request
  6. The NST assesses suitability of different feeding routes and advises on alternative treatment options. It particularly directs nutritional care of patients receiving parenteral nutrition or in transition between enteral and parenteral.
  7. Links to expert capabilities for intravenous catheter and gastrostomy insertion and assists in developing standards for such procedures.
  8. Provides advice on supplies procurement
  9. Supports dietitians, particularly in complex enteral feeding cases
  10. Researches all aspects of artificial nutrition

Nutrition Support Team(s) (NST) Diagram showing areas of responsibilities for the Nutrition Support Team

Nutrition Support Team Diagram

Nutrition Nurse Specialist

  1. Coordinates Nutrition Support Team with nursing care in general
  2. Develops safe and practical nursing techniques with respect to nutrition policy through research and audit
  3. Is a clinical expert in the assessment of nutritional needs and the delivery of treatment.
  4. Provides advanced technical skills in relation to naso-gastric feeding, Percutaneous Endoscopic Gastrostomy, Radiologically Inserted Gastrostomy  and Peripherally Inserted Central Catheters.
  5. Provides specific training in these skills for  nurses, patients and carers.
  6. Contributes to nutrition education  in a broader sense – nursing, medical staff and students
  7. Advises, with others, on nutrition support policy, linking with the Hospital Nutrition Steering Committee to help develop a coordinated strategy, including issues regarding risk management and ethical decision making
  8. Links with specialist units to foster good nutritional care.
  9. Advises on and assists in the  procurement of equipment
  10. Out-patient nutritional support – liaison with community nurses, patients and carers
  11. Maintains records
  12. Participates in and often leads audit
  13. Direct patient advocacy and care – out-patient HEN, HPN. Here the role may come to be seen as that of care manager  for nutritional support patients.

Nutrition Support Team Doctor(s)

Nutrition teams need medical involvement, at both consultant and more junior levels. Some patients may be cared for under the consultant’s primary care, though most will usually be under the principal care of another team.

The doctor(s):

  1. Assess critically the nutritional needs and approach in the context of the patient’s clinical condition and treatment.
  2. Have a critical awareness of nutrition’s impact on quality of life and clinical outcome
  3. Have a detailed insight into diagnosis and medical management and how aspects of nutrition relate to these
  4. Provide  a conduit through which Nutrition is linked to the broader hospital medical consensus and teaching.
  5. Co-ordinate with endoscopy and other gastrostomy-insertion services.
  6. Maintain links with catheter-insertion services
  7. Have the expertise to critically appraise a parenteral or enteral nutrition prescription.
  8. Provide expertise in fluid balance therapy
  9. Support and conduct nutrition-related audit and research
  10. Promote the development and maintenance of the Clinical Nutrition Support Team(s) via business planning in hospital and in liaison with Primary Care Commissioning Trusts.

The Nutrition Support Team Dietitian and the Department of Nutrition and Dietetics

The Nutrition Support Team Dietitian needs to be a senior figure within the Department of Dietetics. He/she provides a vital operational and organisational link between the Team and the Department.

The Department:

  1. Maintains itself as the  principal  source of evidence-based information on food and nutrition and is an important contributor on nutritional assessment and support
  2. Supervises and supports dietitians and dietetic assistants
  3. Provides nutritional advice and expertise in all units of the hospital, including Catering.
  4. Liaises closely with Nutrition Steering Committee and the Nutrition Support Team(s)
  5. Participates in education and training
  6. Assesses diet and nutrition  in more detail than a basic screen.
  7. Provides dietetic advice tailored to individual patient’s needs
  8. Tailors food and supplements to special dietary/nutritional needs
  9. Supervises, analyses and interprets dietary records and recalls.
  10. Prescribes  or helps prescribe enteral feeds and supplements, liaising with doctors, nurses and the nutrition support team
  11. Is “part of the ward” – understands wards and patient problems in order to help solve them
  12. Liaises with clinical staff including ward nurses, SALT, doctors, occupational therapists and social workers etc
  13. Advises about enteral feeding techniques
  14. Advises about parenteral nutrition in liaison with Nutrition  Support Team
  15. Provides community liaison and care (extended roles –links with NNS)
  16. Provides out patient nutritional care and follow up

The Nutrition Support Team Pharmacist and the Pharmacy

Pharmacy is the home base of the Nutrition Support Team pharmacist and will provide input to nutritional care of patients via ward pharmacists, procurement and via drug advisory services. The NST pharmacist links patient care with pharmacy aseptic services and external, often industrial, suppliers particularly in the context of parenteral nutrition.

  1. Assists with pre-admission clinic and ward based identification of nutritionally at risk patients.
  2. Advises on parenteral nutrition composition and compatibilities
  3. Makes safe additions to standard parenteral feeds or tailor-makes feeds according to the patient’s individual requirements using aseptic technique according to national policy.
  4. Ensures that parenteral nutritional solutions are compounded appropriately and are suitable for use. This may be via an in-house aseptic unit or outsourced (pharmacy are responsible for audit of external suppliers).
  5. Appropriately qualified pharmacists may prescribe parenteral feeds, fluids and other necessary therapy.
  6. Assists with monitoring of parenteral feeding
  7. Liaises with home care companies for HPN and patients
  8. Assists in PCT liaison for funding of HPN and high cost drug therapy
  9. Assists with audit of PN usage and service
  10. Contributes to nutrition education
  11. Advises on drug-nutrient and nutrient-nutrient interactions
  12. Advises on drug delivery via naso-enteric and enterostomy tubes and unblocking parenteral and enteral nutrition delivery systems.
  13. Purchase and contract for parenteral (and in some cases, enteral) nutrition products and on local formulary content of nutrition-related products.