Each of these measures requires adequate allocation of time and financial resources to allow clinicians to interact with, teach, and learn from other health care providers, the patient, and family members. The following sections provide further clarification of most of the measures mentioned above.

MEASURES FOR IMPROVING NUTRITIONAL CARE

Patient-Centered, Individualized Care

Patient-centered nutritional care requires an individualized approach. This means that a nutritional assessment should precede decisions concerning nutritional care. The term nutritional assessment covers a wide range of activities, not all of which are appropriate for all individuals. However, basic nutritional assessment for all patients encompasses the measurement of height or length and weight, the determination of hemoglobin or hematocrit values, and the assessment of dietary practices. Abnormal findings may indicate the need for more thorough assessment and intensive nutritional care.

Appropriate patient-centered care often requires that the health care team seek assistance for the patient from outside sources, generally through referral. This assistance may involve, for example, transport of neonates with complex nutrition and feeding requirements to a neonatal intensive care unit; referral to a center for the treatment of inborn errors of metabolism or diabetes mellitus; referral to the Special Supplemental Food Program for Women, Infants, and Children (WIC) for food supplementation and nutrition education; or referral to a program for the treatment of eating disorders. Structured procedures are needed to facilitate implementation of the referral, to track whether appropriate follow-up has occurred, and to indicate how care is to be altered, if at all, as a result.

If transportation or other logistical difficulties make it impossible to arrange for a referral or to incorporate the required specialist into the health care team, the health care provider is urged to consult with a dietitian who specializes in either maternal or neonatal nutrition and with other specialists as needed.



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