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Hobart
Background:
Dieticians are part of the health team in a hospital and one of their jobs is
to calculate the feeds needed for patients who can’t eat and need to be
tube-fed. To do this they must consider factors such as the disease, age, weight,
the times when patients are busy undergoing other treatments such as physiotherapy
and the amount of feed that they can tolerate and also whether the patient prefers
day or night feeds. Often it is a matter of trial and error to see which feed
works best for the patient.
Design Brief
What would be ideal is if there was a computer program that could plan the feeds
regimes. It would need to take into account all the factors which are relevant
to a person’s food needs such as age, weight and energy needs. This could
improve the health outcomes for patients by updating their feed plans more often
than a dietician would normally have time to see them and free dieticians’
time for other work.
Currently dieticians use equations to estimate energy requirements. These energy
requirements are then matched against a variety of enteral formulae to find
the most appropriate choice. The formula is then administered to the patient
over a variety of delivery options. (eg: over a 24 or 12 hour period or 6 shorter
time periods in the day) The formula maybe delivered using a pump or by gravity.
The dietician then completes an enteral feeding form which outlines the name
of the feed, how it is to be administered and the nutritional requirements of
the patient.
It would be ideal if a computer could print out a regime which is updated daily
during the trial phase of a regime, and which could give prompts to nurses of
what to do if something goes wrong, such as if the patient feels nauseous.
In summary:
1. Gather information about the patient and calculate their nutritional requirements
using several equations (to be selected from a list of equations) and looking
at about 8 nutrients. May need to allow manual adjustment by the dietitian for
some patients.
2. Gather information on constraints in determining the feeding regime –
number of hours available for feeding, incrementing rates, max feeding rate
tolerated, medications where feeding needs to be stopped, fluid restriction,
sodium, potassium limits etc.
3. Using information supplied on nutritional composition of about 18 different
commercial tube feeds, determine which feed most closely meets the patient’s
requirements and whether additional water needs to be given. May need to list
nutrients in order of priority if one feed doesn’t meet all requirements
(eg keeping to fluid restriction may be more important than meeting calcium
requirements).
4. Using the best-fit formula, and the other information listed above, display
a report that describes the feeding regime (may build up to target rate through
several increments over a day or two) and summarises the daily nutrient prescription
(eg total protein 89g/day). Allow for the report to be modified manually and
for specific alert statements (for nurses) to be selected from a menu for inclusion
on the printed regime.
5. When the regime has been checked, allow it to be printed for attachment to
the patient’s bed chart (for use by nurses). A sample of our current ‘Regime’
sheet is attached – does not need to look like this but will need to be
in a format that will be approved by RHH Medical Records.
6. Different regimes will be printed as the patient’s condition changes.
So would be good to have a report summarising the history of changes to the
regime for each patient.
7. For research purposes, would also be great if we could group and analyse
the increasing database – eg average daily volume prescribed for a particular
feed, comparative information about different feeds – number of patients
on different types of feeds. These will probably need start and end dates for
the reports so we can track changes in prescribing patterns over time.
8. The extensions to this project (if time permits) relate to:
Refeeding Syndrome – more critical start-up, with more increments in feed
volume over 5-7 days. More nutrients to look at.
Children – just more equations, more patient variables and more nutrients
to consider.
Oral supplements – after calculating energy and protein requirements,
estimate amounts of these already being consumed orally and recommend volume
of nourishing drinks required to make up requirements – about 15 more
products to add to the database of products available.
Home Nutrition Scheme Prescription – another ‘report’ (based
on our current ‘prescription sheet) that lists which products to supply
the patient with after discharge, what volume per month etc, method of feeding
(naso-gastric, oral, gastrostomy, pump, gravity etc), and when the prescription
expires. Will attach a sample.
No preference
Under negotiation
Client Name (person who will be student contact): Jean Symes
Phone Number (business hours): 6222 7204
Email Address: jean.symes@dhhs.tas.gov.au
Address (where students will visit, not PO Box): 7th Floor A Block
RHH – Liverpool St
The estimated software difficulty rating is 4-4.5