Hester Vermeulen

Preoperatieve Voedingszorg: De rol van de verpleegkundige

SamenvattingDe voedingstoestand van een patiënt is een belangrijke factor voor succesvol herstel na een chirurgische ingreep:1 ondervoeding beïnvloedt het herstel negatief.2 Verpleegkundigen spelen een grote rol in het verbeteren van de preoperatieve voedingszorg. Drie lopende voedingsstudies geven inzicht in taken en ervaringen.

Outpatient preoperative oral nutritional support for undernourished surgical patients: A systematic review

AIMS AND OBJECTIVES To evaluate the effects of preoperative nutritional support using a regular diet for undernourished surgical patients at the outpatient clinic. BACKGROUND Undernutrition (or malnutrition) in surgical patients has severe consequences, that is, more complications, longer hospital stay and decreased quality of life. While systematic reviews show the effects of oral nutritional supplements (ONS), enteral and parenteral nutrition in surgical patients, the effects of normal foods and regular diets remain unclear. DESIGN A systematic review. METHODS PubMed, CINAHL, Web of Science, PsycINFO, Cochrane Library and EMBASE were searched up to July 24, 2017. Studies on undernourished patients receiving nutritional support using regular or therapeutic diet, performed preoperatively at the outpatient clinic, were considered eligible. Risk of bias was assessed using the Cochrane Risk of Bias tool. Two reviewers independently performed study selection, quality assessment and data extraction. RESULTS Six studies with moderate risk of bias were included. Interventions were preoperatively performed in mainly oncological outpatients by dieticians and aimed to reach nutrient requirements. Interventions included consults for counselling and advice, follow-up meetings and encouragements, and ONS. Nutritional status, nutrient intake and quality of life improved in supported patients. Improvements were better in counselled patients compared to patients using supplements. Unsupported patients experienced worse outcomes. CONCLUSION Frequent consults with counselling and advice as nutritional support for undernourished patients before surgery result in improvements to nutritional status, intake and quality of life. This statement is supported by weak evidence due to few studies and inadequate methods. RELEVANCE TO CLINICAL PRACTICE Nutritional support should be provided to all undernourished surgical patients during preoperative course. Nurses are in key position to provide nutritional support during outpatient preoperative evaluations.

Medication audit and feedback by a clinical pharmacist decrease medication errors at the PICU: An interrupted time series analysis

Medication errors (MEs) are one of the most frequently occurring types of adverse events in hospitalized patients and potentially more harmful in children than in adults. To increase medication safety, we studied the effect of structured medication audit and feedback by a clinical pharmacist as part of the multidisciplinary team, on MEs in critically ill children.

Much to gain in pain

Het omvangrijke proefschrift ‘Much to gain in pain’ van Sivera Berben betreft inzicht- en kennisontwikkeling voor vroegtijdige herkenning en behandeling van pijn bij aanspreekbare traumapatiënten, zowel in de ambulance als op de spoedeisende hulp (SEH). Hiervoor stelt Berben in haar introductiehoofdstuk een zestal vragen centraal die elk verderop in het proefschrift beantwoord worden met een wetenschappelijk onderzoek.