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Nutrition Support - Developing, Ordering, and Monitoring a Nutrition Support Care Plan - Adult/Pediatric/Neonatal - Inpatient/Ambulatory [6]

Nutrition Support - Developing, Ordering, and Monitoring a Nutrition Support Care Plan - Adult/Pediatric/Neonatal - Inpatient/Ambulatory [6] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Delegation/Practice Protocols, Ambulatory Delegation Protocols


Delegation Protocol Number: 6

Delegation Protocol Title:
Nutrition Support - Developing, Ordering, and Monitoring a Nutrition Support Care Plan -
Adult/Pediatric/Neonatal - Inpatient/Ambulatory

Delegation Protocol Applies To:
UWHC Inpatients: All adult, pediatric and neonatal patients with a consult to evaluate and treat with
parenteral nutrition
UW Health Ambulatory: UW Health ambulatory adult and pediatric patients followed by UW Health
providers referred to Chartwell with an order to evaluate and treat with parenteral nutrition. (Please
note, this protocol does not apply to Chartwell home infusion patients who are followed by providers
outside of the UW Health system)

Target Patient Population:
Adult, pediatric, and neonatal patients requiring parenteral nutrition (PN) receiving care at UW Health
facilities by UW Health providers
Chartwell patients referred to Chartwell by UW Health providers and followed for additional care by UW
Health providers

Delegation Protocol Champions:
Kenneth Kudsk, MD - Department of Surgery – General
Peter Nichol, MD, PhD - Department of Surgery – Pediatric
Luther Sigurdsson, MD - Department of Pediatrics – Gastroenterology

Delegation Protocol Workgroup:
Caitlin Curtis, PharmD, BCNSP - Clinical Nutrition Support Pharmacist
Susan Luskin, PharmD, BCNSP, CNSC - Clinical Nutrition Support Pharmacist
Megan Waltz, MS, RD - Director Culinary and Clinical Nutrition Services
Meghann Voegeli, PharmD - MS - Pharmacy Manager - Nutrition Support
Robin Welcher, MS, RD - Clinic Nutrition Manager

Responsible Department:
Pharmacy Department

Definitions:
SNST – Surgical Nutrition Support Team: pharmacists and nutritionists who treat adult inpatient and
ambulatory patients
PNST – Pediatric Nutrition Support Team: pharmacists and nutritionists who treat inpatient neonates
and inpatient and ambulatory pediatric patients
NST designee: pharmacists, nutritionists, or Chartwell pharmacists who treat adult or pediatric
ambulatory patients
(Note: members of all of the above categories must fulfill the requirements listed below)

Purpose Statement:
The purpose of this protocol is to delegate authority from the ordering provider to the clinician on the
SNST, PNST or Chartwell pharmacist for nutrition assessment and initiation, development,
implementation, monitoring, and adjustment of nutrition support. For Chartwell patients, this
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org

delegation protocol only applies to those patients who are referred to Chartwell by UW Health providers
and are followed for other care by UW Health providers.

Who May Carry Out This Delegation Protocol:
UWHC pharmacists and nutritionists and Chartwell pharmacists who have fulfilled all of the following
requirements:
1. Successful completion of training on the nutrition support team
1.1 Overview: Training will be tailored to the trainee’s practice area, prior nutrition
support experience, and previous knowledge of the electronic medical record.
Training will concentrate on the practice site and patient population(s). Training
includes a combination of one-on-one instruction and computer based training. The
training hours and/or a probationary period may be extended, as needed, at the
discretion the Nutrition Support Pharmacy Manager.
1.2 Supervision: During the training period, the trainee will be directly observed by a
current member of the SNST or PSNT. All orders and notes entered by the trainer
will be reviewed and cosigned by the SNST or PNST trainer during this training
period.
1.3 Training completion: The adequacy of training is assessed by demonstrated
competency to the Medical Director of the SNST, PNST, or their designee.
Assessment includes both clinical judgment and proficient use of computer
technology.
1.4 Inpatient:
1.4.1Training period:
- SNST: 48 hours of training with the SNST.
- PNST: 60 total hours with the PNST, or 40 hours with the SNST plus an
additional 20 hours with the PNST.
1.4.2 Review of PN: a minimum of 50 total PN notes and corresponding PN orders
must be reviewed and cosigned by the SNST or PNST trainer during the training
period. If this is not met, the training period will be extended.
1.5 Ambulatory:
1.5.2 Phase I Training Period: Face-to-Face Training
- Adult PN: 16 hours of training with the SNST.
- Pediatric PN: 24 hours of training with the PNST, or 12 hours with the
SNST plus an additional 12 hours with the PNST.
- After Phase I training is complete, the trainee may move on to Phase II.
1.5.2 Phase II Training Period: External to Phase I and may be completed
remotely:
Review of PN: a minimum of 25 total PN notes and corresponding PN orders must
be reviewed and cosigned by the SNST or PNST trainer during the training period.
Each note and PN order will be reviewed by the PNST or SNST trainer prior to co-
signature. The trainer will document an assessment of each note written by the
trainee. Areas of deficiency will be noted, discussed with the trainee, and
forwarded to the nutrition support pharmacy manager and the trainee’s direct
supervisor, as appropriate. If, based on these assessments, the trainee routinely
shows deficiencies and/or lacks the knowledge of key clinical concepts, the phase
II training period will be extended and re-evaluated after the completion of an
additional five notes and corresponding PN orders.
1.6. Inpatient and Ambulatory:
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1.6.1 Phase I Training Period: Face-to-Face Training
1. SNST: 48 hours of training with the SNST.
2. PNST: 60 total hours with the PNST, or 40 hours with the SNST plus an
additional 20 hours with the PNST.
3. After Phase I training is complete, the trainee may move on to Phase II.
1.6.2 Phase II Training Period:
The ambulatory portion is external and may be completed remotely.
Review of PN: a minimum of 50 PN notes and orders for inpatients and 25 total
PN notes and corresponding PN orders for ambulatory patients must be reviewed
and cosigned by the SNST or PNST trainer during the training period. If this is not
met, the training period will be extended.
2. Certified Nutrition Support Clinician (CNSC) through the American Society for Parenteral and
Enteral Nutrition (ASPEN) or a Board Certified Nutrition Support Pharmacist (BCNSP) through
the Board of Pharmaceutical Specialties.

Guidelines for Implementation in Inpatients:
1. The protocol is initiated by a provider order for a SNST or PNST consult to “write orders” for
inpatients. For ambulatory patients who need PN initiated, a hospitalization should be scheduled.
2. After receiving a consult order, a member of the SNST or PNST assesses the patient and orders
appropriate nutrition support and necessary monitoring within 24 hours.
3. The SNST or PNST assesses the patient’s nutrition needs as related to the patient’s disease
state(s) and nutrition status, and for children, growth requirements, based on UW Health
Parenteral Nutrition – Adult – Inpatient/Ambulatory Clinical Practice Guideline and UW Health
Parenteral Nutrition – Pediatric/Neonatal – Inpatient/Ambulatory Clinical Practice Guideline.
4. The SNST or PNST develops a patient-specific plan for nutrition support and enters orders for
initiation, modification, and discontinuation of PN as indicated by UW Health Parenteral Nutrition
– Adult – Inpatient/Ambulatory Clinical Practice Guideline and UW Health Parenteral Nutrition –
Pediatric/Neonatal – Inpatient/Ambulatory Clinical Practice Guideline.
5. The SNST or PNST orders laboratory tests and procedures (see appendix,) “per protocol with
cosign,” based on practice guidelines at UW Health and the appropriate PN or EN order set, as
required for administration of nutrition support and monitoring of PN or EN based on the UW
Health Parenteral Nutrition – Adult – Inpatient/Ambulatory Clinical Practice Guideline and UW
Health Parenteral Nutrition – Pediatric/Neonatal – Inpatient/Ambulatory Clinical Practice
Guideline.
5.1 For patients in the NICU or patients on the Pediatric Hematology/Oncology service, the
PNST will consult with the primary service before ordering any laboratory tests.
6. The SNST or PNST orders supplemental electrolytes, insulin, and fluid as indicated for proper
maintenance of homeostasis in the patient. This is done in accordance with the UW Health
Guidelines for Use of Concentrated Intravenous Electrolytes in Adults, UW Heath Guidelines for
Use of Oral and Enteral Electrolytes in Adults, and through the use of adult and pediatric
diabetes order sets according to the Standards of Medical Care in Diabetes – Pediatric/Adult –
Inpatient/Ambulatory/Primary Care Clinical Practice Guideline. For Pediatrics, electrolytes and
fluid are ordered in accordance with the UW Health Parenteral Nutrition – Pediatric/Neonatal –
Inpatient/Ambulatory Clinical Practice Guideline and A.S.P.E.N. clinical guidelines.
1

7. A nutrition support attending physician evaluates therapy and monitors patients followed by the
SNST or the PNST on a daily basis.
8. A member of the SNST or PNST documents a daily progress note of nutrition support
assessment, treatment, and monitoring in the electronic medical record (EMR).
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org

9. If an inpatient requires PN upon discharge, a member of the SNST or PNST works with the
discharge planner, primary team, nursing staff, home care company and ambulatory prescriber
to ensure continuity of care as a PN patient transitions from the inpatient setting to the
ambulatory setting. If the ambulatory provider managing PN is a UW Health provider, he/she
may initiate this protocol prior to discharge to the ambulatory setting by entering an order to
consult the SNST or PNST.

Guidelines to Assessment in Inpatients:

1. Purpose: To ensure a consistent, efficient, and safe standard for the initiation, monitoring and
modification of nutrition support formulas, fluid and electrolyte intake, and insulin therapy by
the SNST and PNST.
2. Assessment of Nutrition Status
2.1. Assess patient’s nutrition needs, including an assessment of suitability for enteral versus
parenteral nutrition.
2.2. Global assessment of nutrition status.
2.3. Assessment of protein status.
2.4. Assessment of current weight as a percentage of usual body weight and ideal body weight.
2.5. In children, assessment of weight-for-age, including gestational age when appropriate,
weight for length, BMI for age, and other measures as appropriate for age and disease state.
3. Develop a nutrition care plan
3.1. The nutrition care plan is based on the UW Health Parenteral Nutrition – Adult –
Inpatient/Ambulatory Clinical Practice Guideline, Adult Enteral Nutrition – Guidelines for
Enteral Nutrition, UW Health Parenteral Nutrition – Pediatric/Neonatal –
Inpatient/Ambulatory Clinical Practice Guideline, Pediatric Enteral Nutrition – Guidelines for
Enteral Nutrition.
3.2. The SNST or PNST identifies patient-specific goals and objectives for PN or EN.
3.3. The SNST or PNST develops estimates of macro- and micronutrient requirements and
designs patient-specific feeding formulations.
3.4. The SNST or PNST designs a plan to monitor clinical, nutritional, and metabolic responses to
PN and/or EN.
3.5. The SNST or PNST creates a strategy to identify, prevent, and manage complications of PN
and/or EN.
3.6. The SNST or PNST designs a plan to identify, prevent (if possible), and manage nutrient-
nutrient, drug-nutrient, drug-drug, drug-disease or drug-condition interactions.
3.7. A member of the SNST or PNST educates the patient, caregivers and patient’s health care
providers on the nutrition care plan and communicates changes to the plan as necessary.
4. Implement and maintain appropriate nutrition support
4.1. The SNST or PNST assesses available techniques for vascular and gastrointestinal access and
collaborates with the primary care team as needed to obtain the most appropriate feeding
access.
4.2. A member of the SNST or PNST orders initial nutrition support and necessary monitoring of
nutrition support based on the nutrition care plan. SNST and PNST members initiate central
PN, peripheral PN, or enteral nutrition using the Parenteral Nutrition – Adult, Total Parental
Nutrition – Pediatric, or Enteral Feeding Supplemental order sets.
4.3. A member of the SNST or PNST orders laboratory tests and procedures , “ per protocol with
cosign ,” required for administration and monitoring of nutrition support as indicated in the
UW Health Parenteral Nutrition – Adult – Inpatient/Ambulatory Clinical Practice Guideline,
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org

Adult Enteral Nutrition – Guidelines for Enteral Nutrition, UW Health Parenteral Nutrition –
Pediatric/Neonatal – Inpatient/Ambulatory Clinical Practice Guideline , Pediatric Enteral
Nutrition – Guidelines for Enteral Nutrition, and UWHC Nutrition Handbook.
4.4. The SNST or PNST assesses initial and ongoing requirements for potassium, magnesium,
phosphate and calcium supplementation and orders this supplementation based on UW
Health Guideline for the Use of Concentrated Electrolytes and A.S.P.E.N. Guidelines for
Pediatrics.
4.5. Based on serum blood glucose, point of care glucose measurements and patient history, in
collaboration with the primary team, the SNST or PNST orders insulin via PN, insulin infusion,
or correction insulin using the appropriate PN and diabetes order sets.
4.6. The SNST or PNST orders fluid boluses and modifies maintenance intravenous fluids as
needed to meet a patient’s metabolic requirements within the fluid limits established by the
primary team.
4.7. The SNST or PNST incorporates previously ordered compatible drug therapy into PN
formulations, as medically indicated, to decrease cost, simplify medication administration,
and improve patient safety and overall quality of care.
5. Monitoring PN/EN
5.1. The SNST or PNST performs daily monitoring for all consult service inpatients receiving
nutrition support.
5.2. The SNST or PNST monitors clinical and nutrition metabolic response to the nutrition
support and its components.
5.3. The SNST or PNST completes a daily assessment for metabolic, mechanical, and infectious
complications associated with PN and/or EN for inpatients.
5.4. The SNST or PNST re-evaluates the ongoing requirement for PN or EN on a daily basis. A
member of the SNST or PNST communicates with the delegating provider, as indicated, for
reassessment of nutrition needs and route(s) of therapy.
5.5. Patients receiving inpatient nutrition support managed by the SNST are discussed at least
once weekly with the attending SNST physician or his/her designee for recommendations
and interventions which may optimize the provision of nutrition support. Patients receiving
nutrition support managed by the PNST are discussed at least once daily with the attending
PNST physician or his/her designee for recommendations and interventions which may
optimize the provision of nutrition support.
6. Documentation
6.1. A member of the SNST or PNST documents the initial assessment in the progress note
section of the medical record.
6.2. Daily documentation by a member of the SNST or PNST occurs for all consult patients which
may include:
6.2.1. Adequacy of nutrient intake compared to goals of nutrition care plan
6.2.2. Physical assessment, including clinical signs of fluid and nutrient deficiency and excess
6.2.3. Changes in patient weight
6.2.4. Available laboratory data, noting values outside the normal range
6.2.5. Assessment of major organ dysfunction which could result in change in the nutrition
care plan
6.2.6. Gastrointestinal tract tolerance of EN and glucose, lipid, fluid, and electrolyte
tolerance of nutrition therapy
6.2.7. Signs and/or symptoms of infection based on temperature or lab values
6.2. 8. All electronic record documentation by the SNST or PNST is reviewed by a SNST or
PNST attending physician.
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org


Guidelines for Implementation in Ambulatory Patients:

1. The protocol is initiated by an order from the UW Health provider to “write orders” for the
patient’s parenteral nutrition therapy. Upon initiation, the delegation expires in one year unless
otherwise stated by the delegating provider.
2. For ambulatory patients who need PN initiated, a hospitalization should be scheduled. There
may be exceptions to this in rare circumstances. The Nutrition Support Pharmacy Manager or
designee should be contacted directly via the Surgical Nutrition Support Team pager # 5867 to
discuss extenuating circumstances, assess feasibility, and develop a plan.
3. After protocol initiation, the staffing nutrition support team member determines which nutrition
support team member will be responsible for ambulatory management of the patient – the
SNST, PNST, or Chartwell pharmacist (the “NST designee”). A Chartwell pharmacist will be
responsible for the ambulatory management of the patient only if the patient is receiving
parenteral nutrition (+/- other medications) from Chartwell Midwest Wisconsin.
4. The NST designee assesses the patient and generates orders for appropriate nutrition support
continuation, modification and necessary monitoring within 24 hours.
5. The NST designee assesses the patient’s nutrition needs as related to the patient’s disease
state(s) and nutrition status, and for children, growth requirements, based on UW Health
Parenteral Nutrition – Adult – Inpatient/Ambulatory Clinical Practice Guideline and UW Health
Parenteral Nutrition – Pediatric/Neonatal – Inpatient/Ambulatory Clinical Practice Guideline.
6. The NST designee develops a patient-specific plan for nutrition support and generates orders for
modification of PN as indicated by UW Health Parenteral Nutrition – Adult –
Inpatient/Ambulatory Clinical Practice Guideline and UW Health Parenteral Nutrition –
Pediatric/Neonatal – Inpatient/Ambulatory Clinical Practice Guideline.
7. The NST designee orders laboratory tests “per protocol with cosign,” as required for
administration of nutrition support and monitoring of PN as indicated in UW Health Parenteral
Nutrition – Adult – Inpatient/Ambulatory Clinical Practice Guideline and UW Health Parenteral
Nutrition – Pediatric/Neonatal – Inpatient/Ambulatory Clinical Practice Guideline. In the event
that an Advance Beneficiary Notice is required, the NST designee will contact the delegating
provider.
8. The NST designee orders supplemental electrolytes, and adjusts insulin in the PN and fluid as
indicated for proper maintenance of homeostasis in the patient. In adults, this is done in
accordance with the UW Health Guidelines for Use of Concentrated Intravenous Electrolytes in
Adults, UW Heath Guidelines for Use of Oral and Enteral Electrolytes in Adults. For pediatrics,
electrolytes and fluid are ordered in accordance with the UW Health Parenteral Nutrition –
Pediatric/Neonatal – Inpatient/Ambulatory Clinical Practice Guideline and A.S.P.E.N. guidelines.
9. If the ambulatory patient becomes newly hyperglycemic, the NST designee will contact the
delegating provider for evaluation of the patient and lab results.
10. The NST designee documents a progress note of nutrition support assessment, treatment and
monitoring in the EMR and an electronic copy of this is routed back to the delegating provider.
11. A UW Health delegating provider evaluates therapy and monitors ambulatory patients followed
by the NST designee. Additionally, the delegating provider should complete a physical
assessment of the patient on at least an annual basis.
12. Upon expiration of the delegation protocol, the delegating provider will be contacted to re-
initiate the delegation protocol.

Guidelines to Assessment in Ambulatory Patients:
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Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
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1. Purpose: To ensure a consistent, efficient, safe standard for the monitoring and modification of
nutrition support formulas, fluid and electrolyte intake, and insulin therapy by the NST designee.
2. Assessment of Nutrition Status
2.1. Assess patient’s nutrition needs.
2.2. Global assessment of nutrition status.
2.3. Assessment of protein status.
2.4. Assessment of current weight as a percentage of usual body weight and ideal body weight.
2.5. In children, assessment of weight-for-age, including gestational age when appropriate,
weight for length, BMI for age, and other measures as appropriate for age and disease state (e.g.
disease-specific growth charts).
3. Develop a nutrition care plan
3.1. The nutrition care plan is based on the UW Health Parenteral Nutrition – Adult –
Inpatient/Ambulatory Clinical Practice Guideline, Adult Enteral Nutrition – Guidelines for Enteral
Nutrition, UW Health Parenteral Nutrition – Pediatric/Neonatal – Inpatient/Ambulatory Clinical
Practice Guideline, Pediatric Enteral Nutrition – Guidelines for Enteral Nutrition, and UWHC
Nutrition Handbook.
3.2. The NST designee identifies patient-specific goals and objectives for PN.
3.3. The NST designee develops estimates of macro- and micronutrient requirements and
designs patient-specific PN.
3.4. The NST designee designs a plan to monitor clinical, nutrition, and metabolic responses to
PN.
3.5. The NST designee creates a strategy to identify, prevent, and manage complications of PN.
3.6. The NST designee designs a plan to identify, prevent (if possible), and manage nutrient-
nutrient, drug-nutrient, drug-drug and drug-disease or drug-condition interactions.
3.7. The NST designee consults with the delegating provider or UW Health designee when
patient care conditions or questions arise such as fever greater than 101 degree F, concern for
infection, redness or purulence at the intravenous access site, critical labs as defined by UW
Health laboratory, weight change of greater than 5% in one week, non-functioning line, elevated
WBC, or alterations in hepatic, GI, and renal function.
3.8. The NST designee educates the patient, caregivers and patient’s health care providers on
the nutrition care plan and changes to the plan as necessary.

4. Implement and maintain appropriate nutrition support
4.1. An NST designee generates and modifies orders for PN and necessary monitoring of PN
based on the nutrition care plan.
4.2. An NST designee orders laboratory tests required for monitoring of nutrition support as
indicated in the UW Health Parenteral Nutrition Adult- Inpatient/Ambulatory Clinical Practice
Guideline Patients, Adult Enteral Nutrition – Guidelines for Enteral Nutrition, UW Health
Parenteral Nutrition Pediatric and Neonate – Inpatient/Ambulatory Clinical Practice Guideline,
Pediatric Enteral Nutrition – Guidelines for Enteral Nutrition, and UWHC Nutrition Handbook.
4.3. The NST designee assesses initial and ongoing requirements for potassium, magnesium,
phosphate and calcium supplementation and orders this supplementation based on UW Health
Guideline for the Use of Concentrated Electrolytes.
4.4.Based on serum blood glucose or point of care glucose measurements and patient history,
the NST designee will modify insulin in the PN.
4.5. The NST designee orders intravenous fluids to maintain the patient’s requirements.
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org

4.6. The NST designee incorporates compatible drug therapy (previously ordered by the
provider) into PN formulations as medically indicated to decrease cost, simplify medication
administration, and improve patient safety and overall quality of care.
4.7. Patients receiving parenteral nutrition support managed by the NST designee are assessed
at least once weekly for changes in nutrition state or as indicated by changes in the patient’s
clinical condition (See section 5.1 for indications for less frequent assessments).
Reassessment includes a review of the patient’s current nutrition therapy and evaluation of
changes in nutrition status, feasibility of altering route of administration (e.g. moving from
PN to EN), and adjustment of orders for the nutrition regimen.
5. Monitoring PN
5.1 The NST designee performs weekly assessments for all consult ambulatory patients receiving
parenteral nutrition support. Assessments may occur more or less frequently depending on
the patient’s clinical condition(s). Indications for less frequent assessments include a
combination of the following:
5.1.1. The patient’s PN formula has not changed during the last four weeks
5.1.2. The patient has not been hospitalized within the last four weeks
5.1.3. The patient is compliant with lab draws
5.1.4. The patient is not receiving antibiotics
5.2. The NST designee monitors clinical and nutrition metabolic response to the nutrition
support and its components.
5.3. The NST designee completes a weekly (or as indicated per clinical condition) assessment for
metabolic, mechanical, and infectious complications associated with PN.
5.4. Each time a patient is assessed, a progress note is written by the NST designee in the EMR
and an electronic copy is routed to the delegating provider.
5.5. Each time the patient is assessed, the NST designee re-evaluates the ongoing requirement
for PN.
6. Documentation by a member of the NST occurs for all consult patients and may include, but is not
limited to, the following:
6.2. Adequacy of nutrient intake compared to goals of nutrition care plan
6.3. Changes in patient weight
6.4. Available laboratory data, noting values outside the normal range
6.5. Assessment of hepatic/GI and renal function and alterations which could result in changes in
the nutrition care plan
6.6. Signs and/or symptoms of infection based on temperature or lab values
6.7. Report from patient regarding intake and outputs

References:
1. American Society of Parenteral and Enteral Nutrition Board of Directors. Guidelines
for the use of parenteral and enteral nutrition in adult and pediatric patients. JPEN J
Parenter Enteral Nutr. 2002;26:1-150, Supp.
2. American Society of Parenteral and Enteral Nutrition. Safe practices for parenteral
nutrition. JPEN J Parenter Enteral Nutr. 2004; 28:1-34, Supp.
3. American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) Board of Directors.
Clinical Guidelines for the Use of Parenteral and Enteral Nutrition in Adult and Pediatric
Patients, 2009. JPEN J Parenter Enteral Nutr. 2009 May-Jun;33(3):255-9.
4. American Society of Parenteral and Enteral Nutrition. Enteral nutrition practice
recommendations. JPEN J Parenter Enteral Nutr. 2009; 33:122-167.
5. Boitano M, Bojak S, McCloskey S, McCaul DS, McDonough M. Improving the safety
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org

and effectiveness of parenteral nutrition: results of a quality improvement collaboration.
Nutr Clin Pract. 2010;25(6):663-71.
6. Jesuit C, Dillon C, Compher C; American Society for Parenteral and Enteral Nutrition
(A.S.P.E.N.) Board of Directors, Lenders CM. A.S.P.E.N. clinical guidelines: nutrition
support of hospitalized pediatric patients with obesity. JPEN J Parenter Enteral Nutr.
2010; 34(1):13-20.
7. Koletzko B, Goulet O, Hunt J, Krohn K, Shamir R; Parenteral Nutrition Guidelines
Working Group. Report on the guidelines on parenteral nutrition in infants, children and
adolescents. Clin Nutr. 2005; 24(6):1105-9
8. Martindale RG, McClave SA, Vanek VW, et al. Guidelines for the provision and
assessment of nutrition support therapy in the adult critically ill patient: Society of
Critical Care Medicine and American Society for Parenteral and Enteral Nutrition:
Executive Summary. Crit Care Med. 2009;37:1757-1761.
9. McClave SA, Martindale RG, Vanek VW, McCarthy M, Roberts P, Taylor B, Ochoa JB,
Napolitano L, Cresci G; A.S.P.E.N. Board of Directors; American College of Critical
Care Medicine; Society of Critical Care Medicine. Guidelines for the Provision and
Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient: Society of
Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral
Nutrition (A.S.P.E.N.). JPEN J Parenter Enteral Nutr. 2009; 33(3):277-316.
10. Mehta NM, Compher C, and A.S.P.E.N. Board of Directors. A.S.P.E.N. Clinical
Guidelines: Nutrition Support of the Critically Ill Child. JPEN J Parenter Enteral Nutr.
2009;33:260-276.
11. Mueller C, Compher C, Ellen DM; American Society for Parenteral and Enteral Nutrition
(A.S.P.E.N.) Board of Directors. A.S.P.E.N. clinical guidelines: Nutrition screening,
assessment, and intervention in adults. JPEN J Parenter Enteral Nutr.
2011;35(1):16-24.
12. Ukleja A, Freeman KL, Gilbert K, Kochevar M, Kraft MD, Russell MK, Shuster MH;
Task Force on Standards for Nutrition Support: Adult Hospitalized Patients, and the
American Society for Parenteral and Enteral Nutrition Board of Directors. Standards for
nutrition support: adult hospitalized patients. Nutr Clin Pract. 2010; 25(4):403-14.


Collateral Documents/Tools:
1. UW Health Parenteral Nutrition – Adult – Inpatient/Ambulatory Clinical Practice Guideline
2. UW Health Parenteral Nutrition – Pediatric/Neonatal – Inpatient/Ambulatory Clinical Practice
Guideline.
3. Adult Enteral Nutrition Support Handbook – Guidelines for Tube Feeding
Pediatric Enteral Nutrition Support Handbook – Guidelines for Tube Feeding
4. UW Health Guidelines for Use of Concentrated Intravenous Electrolytes in Adults
5. UW Health Guidelines for Use of Oral and Enteral Electrolytes in Adults
6. Standards of Medical Care in Diabetes – Pediatric/Adult – Inpatient/Ambulatory/Primary Care
Clinical Practice Guideline
7. University of Wisconsin Order Sets):
a. IP Diabetes Management without Pump – Adult (3140)
b. IP Diabetes Management without Pump – Pediatric (2183)
c. IP Insulin Infusion – Adult – Supplemental (1345)
d. IP- Total Parenteral Nutrition – Adult – Supplemental (1354)
e. IP - Total Parenteral Nutrition – Pediatric – Supplemental (1530)
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org


Lab Test Directory

Approved By:
UW Health Ambulatory Protocol Committee: July 2011, July 2014
UWHC Pharmacy and Therapeutics Committee: March 2011, July 2014
UW Nutrition Committee: April 2011, July 2014
UW Health Laboratory Practice Committee- August 2014
UWHC Medical Board: September 2011, September 2014
UW Health Chief Ambulatory Medical Officer: September 2014

Effective Date: September 2014

Scheduled for Review: September 2016










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Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
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