Development of the Pediatric Integrated Nutrition Pathway for Acute Care (P-INPAC) using a modified Delphi technique

Author:

Brunet-Wood Kim1ORCID,Tul-Noor Zujaja2,Bandsma Robert H.J.23ORCID,Carter Laura4ORCID,Fleming-Carroll Bonnie5,Gramlich Leah6ORCID,Hutchison Kim7,Huysentruyt Koen8ORCID,Kalnins Daina9,Marchand Valerie10,Martinez Andrea11,Pai Nikhil12ORCID,Vachon Mélanie13,Hulst Jessie M.23ORCID

Affiliation:

1. Canadian Malnutrition Task Force, Canadian Nutrition Society, Ottawa, ON K1C 6A8, Canada

2. Division of Paediatric Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada

3. Department of Nutritional Sciences, University of Toronto, Toronto, ON M5S 1A8, Canada

4. Nutrition Services, Alberta Health Services, Edmonton, AB, Canada

5. SickKids Learning Institute, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada

6. Division of Gastroenterology, University of Alberta, Edmonton, AB T6G 2G3, Canada

7. Health Sciences Centre, Winnipeg, MB R3A 1R9, Canada

8. Department of Pediatric Gastroenterology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel (VUB), 1090 Brussels, Belgium

9. Department of Clinical Dietetics, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada

10. Division of Paediatric Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, Ste-Justine UHC, University of Montreal, Montreal, QC H3T 1C5, Canada

11. Division of Paediatric Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, IWK Health Centre, University of Dalhousie, Halifax, NS B3K 6R8, Canada

12. Division of Pediatric Gastroenterology, Hepatology and Nutrition, McMaster Children's Hospital, Hamilton, ON, Canada

13. Department of Clinical Nutrition, Centre Hospitalier Universitaire de Québec-Université Laval, Quebec, QC, G1R 2J6, Canada

Abstract

One in three hospitalized children have disease-related malnutrition (DRM) upon admission to hospital, and all children are at risk for further nutritional deterioration during hospital stay; however, systematic approaches to detect DRM in Canada are lacking. To standardise and improve hospital care, the multidisciplinary pediatric working group of the Canadian Malnutrition Taskforce aimed to develop a pediatric, inpatient nutritional care pathway based on available evidence, feasibility of resources, and expert consensus. The working group ( n = 13) undertook a total of four meetings: an in-person meeting to draft the pathway based on existing literature and modelled after the Integrated Nutrition Pathway for Acute Care (INPAC) in adults, followed by three online surveys and three rounds of online Delphi consensus meetings to achieve agreement on the draft pathway. In the first Delphi survey, 32 questions were asked, whereas in the second and third rounds 27 and 8 questions were asked, respectively. Consensus was defined as any question/issue in which at least 80% agreed. The modified Delphi process allowed the development of an evidence-informed, consensus-based pathway for inpatients, the Pediatric Integrated Nutrition Pathway for Acute Care (P-INPAC). It includes screening <24 h of admission, assessment with use of Subjective Global Nutritional Assessment (SGNA) <48 h of admission, as well as prevention, and treatment of DRM divided into standard, advanced, and specialized nutrition care plans. Research is necessary to explore feasibility of implementation and evaluate the effectiveness by integrating P-INPAC into clinical practice.

Funder

Canadian Nutrition Society

Publisher

Canadian Science Publishing

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