2017 - CIRTA
2- Nutrition Management and Total Parenteral Nutrition
18.10 - Development of the New Zealand National Intestinal Failure Service (NZ-NIFS) – navigating unique challenges
Presenter: Helen, Evans, Auckland, New Zealand
Authors: Cate Fraser-Irwin, Briar McLeod, Kim Herbison, Amy Kostrzewski, Kerry McIlroy, Julian Hayes, Helen Evans
Development of the New Zealand National Intestinal Failure Service (NZ-NIFS) – navigating unique challenges
Cate Fraser-Irwin1, Briar McLeod1, Kim Herbison1, Amy Kostrzewski1, Kerry McIlroy1, Julian Hayes1, Helen M. Evans1.
1NZ National Intestinal Failure Service, Auckland District Health Board, Auckland, New Zealand
Background: New Zealand (NZ) has a small population of 4.5 million and a publically funded health service administered by 21 district health boards (DHBs). The 2016 NZ Health Strategy requires care to be delivered close to home to reduce financial and social burdens for families. To establish new national health services projected improvements in patient outcomes and cost containment must be demonstrated. Given the rarity and complexity of intestinal failure (IF), NZ NIFS was launched in 2015 as a national health service.
Aims: To transform IF management in NZ via:
- Establishment of a national IF register
- Development of a national clinical network of multi-disciplinary clinicians and key stakeholders
- Implementation of a model of care to enhance patient safety and outcomes
- Introduction of evidence-based standards of care and guidelines
Methods: Multi-disciplinary experts visited DHBs to launch NZ-NIFS and complete a needs assessment. A national advisory group provided oversight and governance.
Patients receiving intravenous nutrition (IVN) for > 20 days are notified with data points including demographics, pathophysiological classification (ESPEN 2016) and presence of an intestinal rehabilitation plan. Outcome monitoring occurs until the patient is off IVN.
Clinical network activity has included workforce surveys, ratification of key documents, refinement of notification processes and an annual education day.
A shared care model has been developed. Use of telehealth, shared care IT platforms and the alignment with integrated care delivery are key strategic approaches.
Results: Engagement visits identified that smaller DHBs sought active collaboration and assistance with medical and surgical management of IF. While larger DHBs were confident to lead IF management, NZ-NIFS would add value through provision of education, advocacy, clinical leadership and guideline development.
In the absence of a universal definition of IF there has been scepticism about notification to NZ NIFS as early as 20 days. Operationally it enables early discussion and ensures intestinal rehabilitation is the focus of care.
Conclusions: Development of NZ NIFS is a work in progress. This is an early report of a National IF service, it is too early to report outcome measures. Outputs from the clinical network in 2017 will further transform IF care delivery in New Zealand.
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