Exploration of and Application to Practice: 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

CE credit available for dietitians, nurses, pharmacists and physicians

Total Credit Hours:  4.5

On-Demand Activity Start Date:  October 12, 2016

On-Demand ActivityExpiration Date (all CE credit must be claimed by the expiration date):  October 12, 2019

Speakers:

Robert G. Martindale, MD, PhD, Chief, Division of General Surgery; Medical Director, Hospital Nutritional Services, Oregon Health and Science University, Portland, OR

Stephen A. McClave, MD, FASPEN, Professor of Medicine, Division of Gastroenterology/ Hepatology, University of Louisville School of Medicine, Louisville, KY

Beth Taylor, DCN, RD, LD, CNSC, Nutrition Support Specialist, Surgical ICU, Barnes-Jewish Hospital, St. Louis, MO

Format: Online as MP3 files and PDF Handouts

Guidelines Introduction

The significance of nutrition in the hospital setting (especially the ICU) cannot be overstated. Critical illness is typically associated with a catabolic stress state in which patients demonstrate a systemic inflammatory response coupled with complications of increased infectious morbidity, multiple-organ dysfunction, prolonged hospitalization, and disproportionate mortality. Over the past 3 decades, exponential advances have been made in the understanding of the molecular and biological effects of nutrients in maintaining homeostasis in the critically ill population. Traditionally, nutrition support in the critically ill population was regarded as adjunctive care designed to provide exogenous fuels to preserve lean body mass and support the patient throughout the stress response. Recently, this strategy has evolved to represent nutrition therapy, in which the feeding is thought to help attenuate the metabolic

response to stress, prevent oxidative cellular injury, and favorably modulate immune responses.

Improvement in the clinical course of critical illness may be achieved by early EN, appropriate macro- and micronutrient delivery, and meticulous glycemic control. Delivering early nutrition support therapy, primarily by the enteral route, is seen as a proactive therapeutic strategy that may reduce disease severity, diminish complications, decrease LOS in the ICU, and favorably impact patient outcomes.

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 (ASPEN)

Stephen A. McClave, MD*; Beth E. Taylor, RD, DCN*; Robert G. Martindale, MD, PhD; Malissa M. Warren, RD; Debbie R. Johnson, RN, MS; Carol Braunschweig, RD, PhD; Mary S. McCarthy, RN, PhD; Evangelia Davanos, PharmD; Todd W. Rice, MD, MSc; Gail A. Cresci, RD, PhD; Jane M. Gervasio, PharmD; Gordon S. Sacks, PharmD; Pamela R. Roberts, MD; Charlene Compher, RD, PhD; and the Society of Critical Care Medicine† and the American Society for Parenteral and Enteral Nutrition†.  JPEN J Parenter Enteral Nutr published online 15 January 2016.

*Beth Taylor and Steven McClave are co–first authors of this article.

†ASPEN and SCCM are co–last authors.

In response to these recently released guidelines, ASPEN hosted a live training course featuring three of the experts who contributed to the guidelines to educate all members of the healthcare team who work in the critical care setting.  Recordings of this course are now available as an on demand learning opportunity and includes an exploration of the guidelines and then allows for an in- depth assessment of how the guidelines should be implemented into practice for the provision of optimal nutrition care of the adult critically ill patient. 

CE Activity Overall Goal and Target Audience:

This CE activity serves to promote the process of life-long learning for physicians, dietitians, pharmacists, and nurses who specialize in the sciences of clinical nutrition and metabolism in the critical care setting. 

Practice Gap and Goal:

With newly release guidelines for the provision of nutrition therapy in the critically ill patient population healthcare providers need to be adequately trained on best practices to fully implement the guidelines into practice.  The goal of his course is to train healthcare professionals to adequately assess critically ill patients and subsequently provide adequate nutrition therapy to aid with recovery from the illness. 

Learning Objectives:

1. Discuss the strengths and weaknesses regarding the quality of the evidence for development of the guidelines.
2. Describe the concept of nutritional risk.
3. Summarize new supporting literature that reinforces practice concepts that are unchanged from the 2009 guidelines.
4. Discuss new supporting literature that has modified or changed the recommendations from the 2009 guidelines including expanded recommendations for specialized areas of practice (e.g., pancreatitis, trauma, burns, sepsis, post-operative, chronic critically ill, obesity).
5. Utilize the guidelines to guide clinical decisions in a variety of complex patient cases.

Speaker Credentials and Affiliations:

Robert G. Martindale, MD, PhD, Chief, Division of General Surgery; Medical Director, Hospital Nutritional Services, Oregon Health and Science University, Portland, OR

Stephen A. McClave, MD, FASPEN, Professor of Medicine, Division of Gastroenterology/ Hepatology, University of Louisville School of Medicine, Louisville, KY

Beth Taylor, DCN, RD, LD, CNSC, Nutrition Support Specialist, Surgical ICU, Barnes-Jewish Hospital, St. Louis, MO

Requirements for Successful Completion:
To obtain CE credit for this activity, attendees must listen to the education recording, complete an online knowledge assessment for each education recording and achieve a score of 100%, and complete an online activity evaluation. All CE credit must be claimed prior to the expiration date.    Note:  successfully completing the posttest is required for nurses, pharmacists, and physicians, not dietitians.  Dietitians may claim credit for viewing/listening to the recording per CDR guidelines. 

Accreditation Statements/Continuing Education Credit:

Nurses, Pharmacists, and Physicians

The American Society for Parenteral and Enteral Nutrition (ASPEN) is accredited by the American Nurses Credentialing Center (ANCC), the Accreditation Council for Pharmacy Education (ACPE), and the Accreditation Council for Continuing Medical Education (ACCME), to provide continuing education for the healthcare team.

ASPEN designates this enduring/on demand activity for a maximum of 4.5 contact hours (0.45 CEU). Knowledge activity. 

ASPEN designates this enduring material for a maximum of 4.5 AMA PRA Category 1 Credits ^TM per activity. Physicians should only claim credit commensurate with the extent of their participation in the activity.

ASPEN is approved by the California Board of Registered Nursing, Provider CEP 3970.

ACPE UAN:  0216-0000-16-136-H01-P

Dietitians

ASPEN, Provider Number AM005, is a Continuing Professional Education (CPE) Accredited Provider with the Commission on Dietetic Registration (CDR).   Registered dietitians (RDs) will receive continuing professional education units (CPEUs) for completion of this program / materials.CDR level 2 for 4.5 CPEUs.  Dietitians may post comments on this program on www.cdrnet.org.

Policies/Information:

Non-Commercialism:  ASPEN subscribes to the ACCME Standards for Commercial Support.  ASPEN does not provide programs that constitute advertisement or include promotional materials.  ASPEN does not endorse any products. 

Computer Requirements and Technical Support: 

Participants will need a computer with internet connection and it is recommended that end users' devices satisfy the following requirements:

• OS: Windows, Mac
• Browser: Internet Explorer 7 or higher, Firefox, Chrome, Safari
• Javascript & Cookies enabled
• Adobe Flash Player 9.124.0 or higher
• Recommended RAM: 512MB+

Mobile support

• Apple iPad/iPhone running HTML5
• Android Device running Flash

For technical difficulties please contact Digitell Inc. Customer Support at: 1-800-679-3646

Office hours are between 9AM to 5PM ET, Monday through Friday

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Refund Policy: Refunds are not available. 

Grievances:  Grievances must be submitted in writing to Director of Education and Research at ASPEN 8630 Fenton Street. Suite 412. Silver Spring, MD 20910.

Commercial Support and Sponsorship:
No commercial support or sponsorship has been received for this on demand continuing education activity.

Commercial Relationships Disclosures and Conflicts of Interest (COI) of Speakers/Faculty

• Robert Martindale:  while not related to the course content, Dr. Martindale has worked with several commercial entities as listed below.  All information presented by Dr. Martindale will be evidence-based.
• Grant from Metagenics, Consulting fee from Abbott and Nestle
• Stephen McClave:  while not related to the course content, Dr. McClave has worked with several commercial entities as listed below.  All information presented by Dr. McClave will be evidence-based.
• Nestle, Metagenics, and Abbott as a member of their speaker’s bureau, and consultant for Metagenics and Covidien. Receives honoraria 
• Beth Taylor: nothing to disclose