Magazine article Drug Topics

Food Plan

Magazine article Drug Topics

Food Plan

Article excerpt

Pharmacists involved in the provision of nutritional care will have new standards to meet when the Joint Commission on Accreditation of Healthcare Organizations comes to call. Included in the 1995 standards are directives that specifically address nutrition.

The American Society for Parenteral & Enteral Nutrition (ASPEN) was one group that encouraged JCAHO to look at the nutrition care area, explained Jay Mirtallo, clinical pharmacist at Ohio State University Medical Center, speaking at a seminar at ASHP's first home care meeting in Chicago recently. While references to nutrition care were included in some existing JCAHO standards, in no place were they pulled together as a separate entity, Mirtallo explained. ASPEN felt it was important to develop standards that pertain just to nutrition care because of the 'elevated importance of nutrition as a therapeutic tool in the patient care process."

To design the new standards, a JCAHO Task Force, including Mirtallo and other members of ASPEN, identified specific functions in the nutrition i care area from which to develop standards. After the directives are implemented on Jan. 1, JCAHO will evaluate them to determine if there are problems in interpreting them.

As defined by JCAHO, nutrition care includes parenteral or enteral nutrition or any modification of a regular diet. Performance-based in nature, the new directives stress that a multidisciplinary approach should be taken when an organization provides nutrition care; that is, pharmacists, physicians, nurses, dietitians, and other ancillary personnel should be included in the nutrition care function.

Some of the standards for this area are included in a separate nutrition care section in the Care, Treatment, and Services Chapter of the accreditation manual, while others are included in other chapters. In laying out the new directives, JCAHO has defined five basic areas of the nutrition care process:

* Screening, assessing, and reassessing patients' needs

* Developing a plan for nutrition therapy

* Prescribing or ordering products

* Preparing, distribution, and administering products

* Monitoring the nutrition care process

In assessing an organization, JCAHO will look for certain criteria in each of the following areas:

Screening, assessing, reassessing patient needs: JCAHO will look for verification that an organization has a system in place to screen for a patient's nutritional status if nutrition care falls within the scope of services that an organization offers.

An assessment of a patient must be conducted by a qualified individual, Mirtallo explained. Taken into account in the initial assessment are physical exams, lab values, medications that could alter nutritional status, food intolerance and allergies, and any religious, cultural, ethnic, and personal food preferences that could affect a patient's nutritional status.

Developing a plan for nutrition therapy: JCAHO will look for validation to assure that a nutrition care plan is developed for those patients with nutrition deficiency. JCAHO will not expect to see a nutrition care plan for those patients on a regular diet, Mirtallo noted.

Included in the care plan must be "quantifiable goals, with actions and interventions implemented." JCAHO will further look to see that there is a "time frame in which the plan is carried out and the patient's problems resolved," Mirtallo explained.

Prescribing or ordering products: Food and nutrition therapies must be prescribed by authorized individuals and include specialized orders and/or solutions when applicable. …

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