Role of Dietitians in the Leadership of Evidence Based Practice, Quality and Audit

Duane Mellor, Elke Naumann, Christophe Matthys, Alison Steiber, Maria Hassapidou

Research output: Contribution to journalConference abstractpeer-review

Abstract

Increasingly, there has been a drive to evidence-based practice (EBP) in healthcare, nutrition, and dietetics has as a profession incorporated into its practice. However, it is important to consider what EBP is and what it is not. In the workshop led by the Research and Evidence Based Practice committee (REBPc) of the European Federation of Associations of Dietitians (EFAD) as part of the 10th EFAD conference in Rotterdam, the role of dietitians was debated in the leadership EBP, quality, and audit. Initially, Christophe Matthys, Associate Professor from KU Leuven set the scene, by critically considering the gold standard definition of EBP as set out by Sackett (1996), with its 3 dimensions of research data, clinician experience, and patient preferences. The historic approach to practice based on clinical experience and continuing practice models have almost become habitual. To challenge and change the “we have always done things this way” mode of practice and move toward the integration of EBP in a real life setting necessitates the involvement and interaction with a range of stakeholders. These stakeholders range from clinicians themselves, in this case dietitians, through the wider healthcare team, including nurses along with patients, healthcare commissioners, and politicians. An example of how EBP guidelines have been developed and implemented by the group in Leuven is dietary advice given prior to a colonoscopy (Vanhauwaert et al, 2015, Vanhauwaert, Matthys & Joossens, 2014). Following a systematic review, on which the guideline was based, 2 major conclusions were made. Firstly, the name of the diet needed to be changed, as “low residue” had too variable meaning and could not be objectively defined. Secondly the number of days that patients needed to follow the diet could be significantly reduced, which had the potential to reduce cost if patients were in hospital as well as reducing the burden on the patient. Although, the logic to these conclusions are apparent, the first barrier these guidelines faced were that dietitians were reluctant to a change of name and a quantification of the diet. Then, the second key barrier came from nurses, who had a very specific perception of the diet, and how long it was necessary to follow, prior to the investigation. Therefore, highlighting that guidelines often have to be adapted to allow it to be implemented and their need to compromise the absolute findings from systematic reviewing of the literature in order to effectively implement into practice, healthcare teams need to be engaged and consulted in the process (Cochrane et al., 2007). This adaptive approach also means that guidelines can be adapted to suit the limitations of a healthcare system or meet the needs and priorities of the community they have been developed to treat. The need to support the effective implementation of dietetic treatment depends heavily on monitoring how dietetic interventions are delivered and their outcomes. Elke Nauman, Associate Professor from HAN, highlighted the work on data sets that need to be collected to demonstrate effective care and patient outcomes. In previous studies, the group in HAN investigated what the minimum data set should be, which needs to be collected by dietitians treating patients at risk of cardiovascular disease to be able to demonstrate the effectiveness of dietetic treatment. Following the identification of the minimum data set, further work was undertaken to investigate facilitators and barriers in collection of this minimal data set. Then this will be used to develop a digital tool that enables dietitians to register results of treatment. A semi-structured interviews methodology was used where dietitians were used to identify facilitators and barriers for data collection. Outcomes were then used to develop a (draft) digital tool, using “lean” methodology. Key facilitators and barriers were identified at the level of dietitians (e.g., experience in measurements), clients (e.g., expectation of dietetic treatment), organizations (e.g., time), and measurements (e.g., easy to use) and these were then used to develop a draft digital tool. It is important to use systematic methodologies to develop draft digital tools that facilitates registration (Cooery et al., 2017). Whether this tool will indeed create transparency of dietetic results needs to be confirmed. The theme of data collection to improve dietetic practice and patient care and outcomes was continued by Dr Alison Stieber, from the Academy of Nutrition and Dietetics who highlighted the value of ANDHII (https://www.andhii.org/info/#Intro ) as a fully functional health informatics infrastructure system. The value for this type of approach helps to systematically use nutritional diagnosis, dietetic terminology, and monitor and evaluate patient care. This allows for the economic evaluation of dietetic care, along with the standardization of care and practice, resulting in improved patient care an...
Original languageEnglish
Pages (from-to)72-73
JournalAnnals of Nutrition and Metabolism
Volume72
DOIs
Publication statusPublished - 1 Sep 2018
Event10th EFAD Conference
- Rotterdam, Netherlands
Duration: 28 Sep 201829 Sep 2018

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