Management of the clinical

nutrition service

M.N.C. Lucía A. González Ramírez, NC

1. In context
2. Clinical nutrition service objectives
3. FODA
4. Mexican normativity
5. Activity
6. Conclusion
Objective
The student identifies the general objectives of the clinical nutrition
service and the related normativity in Mexico.
1. In context
Each country has:
• Defined health structure.
• Specific gastronomic and cultural characteristics.
• Certain lifestyles and schedules
• Precise teaching curricula

Difficult to import structures from others

Charro Salgado. Plan de organización de las unidades de nutrición clínica y dietética
2. Clinical Nutrition Service
Objectives
Contribute to recover or maintain an acceptable state of health, in the
shortest time possible and at the most acceptable costs.

Charro Salgado. Plan de organización de las unidades de nutrición clínica y dietética

1. Improve the nutritional status of patients and prevent malnutrition
during their hospital stay.

2. Contribute to achieve the highest level of user satisfaction.

3. Apply scientific criteria to the guidelines of both diet therapy and

medical nutrition treatment.

4. Collaborate with the administration in the control of the expense derived

from the activity of the unit.

Charro Salgado. Plan de organización de las unidades de nutrición clínica y dietética

1. Assistance

2. Teaching

3. Management

4. Research

Charro Salgado. Plan de organización de las unidades de nutrición clínica y dietética

1. Assess the nutritional status of hospitalized patients and prescribe
adequate diets.

2. Follow- up of the patients with diet therapy

3. Prepare the codified diet manual.

4. Plan the basal diet with optional menus at reasonable costs, in

collaboration with the hospital service.

5. Plan the codified therapeutic diets.

Charro Salgado. Plan de organización de las unidades de nutrición clínica y dietética

6. Program the PN formulas together with the pharmacy.

7. Select mixtures of EN

8. Develop MNT protocols.

9. Prescription, control and monitoring of artificial nutrition in

hospitalized patients and outpatient consultation.

Charro Salgado. Plan de organización de las unidades de nutrición clínica y dietética

10. Control of the reception, storage, processing and distribution of
food, in collaboration with management services.

11. Authorize the necessary changes in any type of diet.

Charro Salgado. Plan de organización de las unidades de nutrición clínica y dietética

Undergraduate and graduate training.

1. Continuous training of the staff of the unit and other hospital

professionals.

2. Training in the health area

Charro Salgado. Plan de organización de las unidades de nutrición clínica y dietética

1. Preparation of annual plans and technical advice to the managers.

2. Coordination of the services involved through the Nutrition

Commission.

3. Evaluation of the operation and effectiveness of the unit.

4. Control of ambulatory care in nutritional support.

Charro Salgado. Plan de organización de las unidades de nutrición clínica y dietética

1. Clinical and experimental research.

2. Participation in public health campaigns.

3. Carrying out epidemiological studies.

Charro Salgado. Plan de organización de las unidades de nutrición clínica y dietética

3. FODA
(SWOT)
Identify and analyze the Strengths and Weaknesses of the institution or
organization, as well the Opportunities and Threats, which presents the
information that has been collected.

It should be used when developing a strategic plan, or when planning a

specific solution to a problem.

Secretaría de Salud. Análisis FODA

Real Life Example
Identify and analyze the Strengths and Weaknesses of the institution or
organization, as well the Opportunities and Threats, which presents the
information that has been collected.

It should be used when developing a strategic plan, or when planning a

specific solution to a problem.

Secretaría de Salud. Análisis FODA

4. Mexican normativity
• Actions intended to positively change a nutrition related behavior,
environmental condition, or aspect of health status.

• Directed to the etiology or case of the problem identified in the PES

statement.

• Sometimes the intervention must be directed toward the signs and

symptoms if the RDN cannot impact the etiology.

AND, eatright.org, 2017

Clinical Practice Guidelines
• CPGs serve as a framework for clinical decisions and supporting best
practices.

• Are statements that include recommendations intended to optimize

patient care.

• They are informed by a systematic review of evidence, and an

assessment of the benefits and harms of alternative care options.

The American Academy of Family Physicians, 2017

Some CPG
• ASPEN Board of Directors and the Clinical Guidelines Task Force.
American Society for Parenteral and Enteral Nutrition. JPEN J Parenter
Enteral Nutr. 2002 Jan-Feb;26(1 Suppl):1SA-138SA.
• Secretaría de Salud (2010). Norma Oficial Mexicana NOM-015-SSA2-
2010, Para la prevención, tratamiento y control de la diabetes
mellitus, México, Diario Oficial de la Federación.
• Secretaría de Salud (2010). Norma Oficial Mexicana NOM-030-SSA2-
2009, Para la prevención, detección, diagnóstico, tratamiento y
control de la hipertensión arterial sistémica, México, Diario Oficial de
la Federación
Some CPG
• Secretaría de Salud (2011). Norma Oficial Mexicana NOM-037-SSA2-
2012. Para la prevención, tratamiento y control de las dislipidemias,
México, Diario Oficial de la Federación.

• Soriano, C.S. "Definición y clasificación de estadios de la enfermedad

renal crónica. Prevalencia. Claves para el Diagnóstico Precoz. Factores
de riesgo de enfermedad renal crónica", Nefrología, México, núm. 6,
2004, pp. 27-34
Intervention Objectives
They depend on the individual characteristics of the patient.

• Age, Sex
• Medical Diagnostic
• Economic Status
• In or out- patient
•…

Anthony, PS. Nutritional screening tools for hospitalized patients. Nutr Clin Pract. 2008; 23(4): 373-382.
Examples…
ASPEN Guidelines for critically ill patients (2016):
• Attenuate the metabolic response to stress
• Prevent oxidative cellular injury
• Favorably modulate immune responses.
Examples…
ADA Guidelines:
• Promover y mantener hábitos de alimentación saludables favoreciendo una dieta de alto
valor nutrimental para lograr un adecuado control glucémico, lipídico y de TA.

• Favorecer pérdida de peso de ser necesario.

• Prevenir o retrasar la aparición de complicaciones.

• Cubrir requerimientos de micro y macronutrimentos.

• Mantener el placer de comer.

• Prevenir y tratar oportunamente las hipoglucemias.

5. Activity
Instructions
Objective: Student analyzes the components of the SWOT analysis in a real life example.
Modality: Individual
Description
• Construct a SWOT analysis of the School of Nutrition of the Universidad Anahuac Mayab.
6. What are your conclusions?
 Thanks!
M.N.C. Lucía A. González Ramírez, N.C.

nut.lucia.gonzalez@gmail.com