Fuel for Recovery
A loved one is in the intensive care unit, medicated, undergoing tests, maybe even on a ventilator to breathe. Amid all that activity, careful attention is also being paid to a basic necessity: sustenance.
“Patients with proper nutritional support
are more likely to get out of the ICU
quicker, go home sooner, and recover
—Dr. Michael Smith, chief of the medical
staff at Community Hospital
“Providing the appropriate nutrition improves recovery among critically ill patients,” says Dr. Michael Smith, Monterey gastroenterologist and chief of the medical staff at Community Hospital. “Patients with proper nutritional support are more likely to get out of the ICU quicker, go home sooner, and recover more fully.”
Critical-care nutrition involves providing nutritional support to patients who can’t eat any food or enough food because of an illness or surgery. Nutrition may be provided through tube feedings directly into the digestive tract or through an intravenous solution. This liquid diet is customized to ensure that each patient gets the proteins, carbohydrates, fats, vitamins, and minerals he or she needs.
Specially trained clinical staff members determine the amount and type of nutrition as well as the appropriate delivery system for each patient, with the goals of improving health, minimizing infections, and enabling patients to live as normally as possible.
“It is challenging because there can be so much going on with these patients,” Smith says. “Our nutrition support team takes everything into consideration to come up with the best individual nutritional support plan.”
The team is multidisciplinary and includes clinical dietitians, doctors, nurses, and pharmacists. One of the keys to the team approach, says Cheryl Sabillo, a clinical dietitian and certified nutrition support clinician, is that the dietitians go on rounds with the doctors, seeing the patients and personally interacting with the rest of the care team.
“Our dietitians are in the forefront rather than operating only at a computer,” Sabillo says. “When you see patients in person, you can be proactive, make better recommendations. You can have one-on-one conversations with the doctors, nurses, and other members of the healthcare team, and are able to ask them, ‘How can we help you give better care?’ ”
Community Hospital has used this team approach for almost 30 years, Smith says, because it works. That belief was validated early this year when Community Hospital received a “Best of the Best” award — the only one given to a U.S. hospital — in an international research survey of the best practices for providing nutrition to critically ill patients.
Clockwise, from left: Connie Hurlbert, Gloria
Maxon, Suzanne Le Bon, Cheryl Sabillo, and
Janna Dreisbach. All five are registered dietitians
and Hurlbert, Le Bon, Sabillo and dreisbach are
also certified nutrition support clinicians.
The award was based on information collected in the annual International Nutrition Survey, sponsored by the clinical research group Critical Care Nutrition.
Ranked seventh among the nearly 152 institutions worldwide that took part in the survey, Community Hospital was the highest-ranking U.S. hospital and the only one to place in the top 10.
Sabillo coordinated Community Hospital’s participation in the survey. Participating hospitals collected information on a minimum of 20 adult patients who were in intensive care units and on mechanical ventilators to help them breathe. The information collected included patient characteristics, type and amount of nutrition received, blood sugar levels, length of hospital stay, and recovery details.
Participating hospitals received a performance report highlighting strengths and weaknesses in comparison to other ICUs. The top 10 received the Best of the Best award. As a Best of the Best winner, Community Hospital has become a model for other ICUs.
“The survey is really a quality improvement initiative,” Sabillo says. “It is a systematic way to collect information from a variety of institutions in different countries on current nutrition practices. The results enable our clinical nutrition team to compare our practices to other practices. Such comparisons illuminate differences, highlight strengths and weaknesses, and hopefully lead to improvements.”
While the survey focused on critical-care nutrition, inpatient clinical dietitians work throughout the hospital, helping to ensure that all patients are getting appropriate nutrition and hydration.
There are 10 full-time or part-time inpatient clinical dietitians on staff. Sabillo and four others — Janna Dreisbach, Connie Hurlbert, Susan Lewis, and Suzanne Le Bon — are also certified nutrition support clinicians, a credential attained through a rigorous examination that tests their knowledge of nutrition support. Pharmacist Patricia New is a board-certified nutrition support pharmacist.
“When we have patients who need our services,” Sabillo says, “we look at the whole picture — including their disease, medication, and diet and weight history — and make an assessment of how we can help. We can’t cure a disease, but we may be able to help slow or stop its progression using good nutrition and adequate vitamin and mineral supplementation.”