Quality standard

Quality statement 4: Specialist nutritional multidisciplinary team

Quality statement 4: Specialist nutritional multidisciplinary team

Quality statement

Preterm and term babies receiving neonatal parenteral nutrition are cared for by healthcare professionals who have access to a specialist nutritional multidisciplinary team.

Rationale

Access to a specialist nutritional multidisciplinary team helps to ensure a safe and effective service. The multidisciplinary team can be based locally or within a clinical network. It does not need to discuss or review all preterm and term babies receiving neonatal parenteral nutrition, but it can provide advice and support for healthcare professionals, for example, by ensuring there are protocols for starting and stopping neonatal parenteral nutrition and by assisting with complex cases.

Quality measures

The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.

Structure

a) Evidence of local arrangements to ensure a specialist nutritional multidisciplinary team is in place, either within the trust or the clinical network.

Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally, for example, service level agreements and records of meetings.

b) Evidence of local arrangements to ensure that the specialist nutritional multidisciplinary team is responsible for governance around delivery of neonatal parenteral nutrition and provides support for healthcare professionals delivering it.

Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally, for example, clinical protocols.

Process

Proportion of neonatal units that deliver parenteral nutrition and have access to a specialist nutritional multidisciplinary team.

Numerator – the number in the denominator that have access to a specialist nutritional multidisciplinary team.

Denominator – the number of neonatal units that deliver parenteral nutrition.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from local service agreements.

What the quality statement means for different audiences

Service providers (such as neonatal clinical networks and neonatal and paediatric units) ensure that healthcare professionals caring for babies receiving neonatal parenteral nutrition have easy access to a specialist nutritional multidisciplinary team. This can be a locally based multidisciplinary team or part of the neonatal clinical network.

Healthcare professionals (such as neonatal and paediatric consultants, nurses, dietitians and pharmacists) access a specialist nutritional multidisciplinary team if they need clinical advice, assistance with treatment planning or are treating a baby with complex needs.

Commissioners (such as clinical commissioning groups, integrated care systems and NHS England) ensure that they commission services that have or have access to specialist nutritional multidisciplinary teams and ensure they are available to healthcare professionals in neonatal and paediatric units when needed. The multidisciplinary teams are responsible for governance and provide support for healthcare professionals delivering neonatal parenteral nutrition.

Newborn babies who are being given nutrition directly into their bloodstream through a vein (intravenously) are cared for by healthcare professionals who can easily access other specialists in neonatal nutrition for advice and support.

Source guidance

Neonatal parenteral nutrition. NICE guideline NG154 (2020), recommendation 1.9.1

Definitions of terms used in this quality statement

Neonatal parenteral nutrition

Nutrition given directly into the bloodstream through a vein (intravenously) in newborn babies who cannot take adequate milk feeds because they are too small or very unwell. It includes nutrients such as amino acids, glucose, fat, electrolytes, vitamins and trace elements. The neonatal period is defined as up to 28 days after birth for babies born at term and 28 days after their due birth date for those born preterm. [Adapted from NICE's guideline on neonatal parenteral nutrition and expert opinion]

Specialist nutritional multidisciplinary team

The specialist nutritional multidisciplinary team should include a consultant neonatologist or paediatrician with a special interest in neonatology, a neonatal pharmacist and a neonatal dietitian, and should have access to the following:

  • a neonatal nurse

  • a paediatric gastroenterologist

  • an expert in clinical biochemistry.

It should be responsible for:

  • governance, including:

    • agreeing policies and protocols for the neonatal parenteral nutrition service, including when neonatal parenteral nutrition should be discontinued

    • ensuring that policies and protocols for neonatal parenteral nutrition are followed and audited

    • monitoring clinical outcomes

  • supporting delivery of parenteral nutrition, including:

    • providing clinical advice

    • providing enhanced multidisciplinary team input for preterm and term babies with complex needs, for example, babies with short bowel syndrome who may need long-term parenteral nutrition.

The specialist nutritional multidisciplinary team can be based locally or within a clinical network. It does not need to discuss or review all preterm and term babies receiving neonatal parenteral nutrition. [Adapted from NICE's guideline on neonatal parenteral nutrition, recommendations 1.9.1, 1.9.2 and 1.9.3, and expert opinion]