March 27, 2009

Evidence-based practices fuel dietitian program’s success

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Registered dietitian Beth Mills, M.S., left, reviews new feeding tube safety features with Carla Stroud, R.N. (photo by Susan Urmy)

Evidence-based practices fuel dietitian program’s success

Registered dietitians at Vanderbilt Medical Center are at the national forefront in implementing evidence-based practice, according to Chris Biesemeier, M.S., R.D., director of clinical nutrition.

The staff of 30 registered dietitians and six dietetic technicians regularly consults the American Dietetic Association's online Evidence Analysis Library, a source for evidence-based practice guidelines and systematic reviews.

Biesemeier said that using evidence makes VMC's dietitians more confident in their recommendations.

“Care providers strive to do the right thing. They want to see positive outcomes. So when there's a choice between several alternatives, they're going to select the one that's shown most likely to work,” she said. “I think my staff would say that they treat their patients like they would want their family members to be treated. We take our work that seriously,” she said.

Dietitians access the library on their own, but Biesemeier identifies new findings and disseminates relevant information to staff.

“The evidence library has inclusion and exclusion criteria for articles used to develop practice guidelines, so we know we're seeing an apples-to-apples comparison of different treatments. Library reviewers look at the quality of articles to determine the strength of supporting evidence for guideline recommendations. We know we can trust the guidelines,” Biesemeier said.

The way dietitians use evidence depends on whether they treat inpatients or outpatients.

“In the inpatient setting, the dietitian translates evidence into care protocols and nutrition therapy recommendations for the team, and explains nutrition care to the family,” Biesemeier said.

“In the outpatient setting, while dietitians provide information, the focus of their therapy is applying information to make behavior changes. It's presenting options and helping patients evaluate benefits and costs, to make choices they can implement.”

Dietitians are an integral part of unit care teams and attend rounds daily. Many of VMC's dietitians are also board certified in specialty practice areas.

Beth Mills, M.S., R.D., is certified in nutrition support and works in the trauma unit, where she identifies patients who need enteral nutrition (tube feeding). Evidence shows that starting enteral nutrition in resuscitated patients who cannot eat within 24-48 hours of admission can translate into fewer infections and help prevent pressure ulcers.

Jane Greene, R.D., C.S.R., is board certified in renal nutrition and is the kidney disease education coordinator in the Nephrology Clinic.

Evidence shows that a patient's food choices have a direct link to the preservation of kidney function and delaying the start of dialysis.

Biesemeier said dietitians have worked passionately to secure their place on their care teams, and one of the biggest advantages of their work is cost effectiveness.

“The ultimate goal of nutrition therapy is improving quality of life and giving people an opportunity to live long and healthy lives. Nutrition therapy is also cost effective,” she said.

“It costs less to prevent chronic conditions, like diabetes or heart disease, than to treat them after they've developed. For individuals with chronic conditions, early and effective management leads to better quality of life, as well as reduced health care expenses.”

Biesemeier has worked to implement evidence-based practice for more than nine years, and now that dietitians are comfortable using this approach, they have begun contributing to the literature through journal publications and book chapters.

“We're at the point of collecting our outcomes data and using data to improve performance. This is our direction — defining clinical questions and collecting data to answer them to improve nutrition care. Do patients do better if we use a protocol? What are the outcomes we're seeing?

“As we have data that answer our questions, we will share our results in peer-reviewed journals,” Biesemeier said.

In March, the dietitians and dietetic technicians celebrated National Nutrition Month, which highlighted the importance of making informed food choices and developing sound eating and physical activity habits.