Improving nutrition protocols in your practice

As a Practice Manager, it often is brought to my attention when the nurse’s or vet’s time-honored ways of treating, preventing or managing different conditions no longer stack up with the latest research and need to be updated. The first step in solving a problem, is recognising we have one; while I often spot when things are less than ideal, it is everyone’s responsibility to ensure that we aren’t doing things just because we always have, but we are focusing on making sure we are continuously improving when new evidence and research is available to us.

Now how does this relate to nutrition? Well, I think anyone who is familiar with my blog posts knows exactly where I’m going with this! There are many practices that I see clinics still doing that not only are outdated, but are potentially damaging to our patients. One being feeding chicken and rice to compromised patients.

But how do we create change?

So often I have nurses or vets reaching out to me, tearing their hair out, trying to communicate with their management or team to get them to change their ways and improve their recommendations in practice. But it’s not so difficult – here are some simple steps to follow to build a new protocol for your practice and pitch it to your team!

Step One – Research:

You’ve likely identified or encountered a problem and want to change things for the better. Focus on that one thing you’d like to change, and study it. If you’re not sure where to start, consider what the most common conditions you see in practice are, and what your current recommendations are. From here, focus your attention on one of those things you think could be improved in your approach to nutritional management.

• Have a look at the current research and keep up to date on the latest research available on the topic you are focusing on – for example, what has been done traditionally and what is now recommended? What is the evidence supporting the new protocols and why is this change important?

• PubMed and Google Scholar provide searchable access to journal articles many of which are freely available to access.

• Familiarise yourself with the Key Nutritional Factors of conditions you frequently see in practice (available for free in the Small Animal Clinical Nutrition textbook online)

• If you have access to nutrition specialists or a nutritional consulting service, ask them what they would do and why!

• What is the research the current protocols are based on? Do we have updated research now?

• Ask your team about why they recommend what they do, and if there is evidence supporting this

Step Two – Collect Data:

Now it’s time to collect some statistics! That sounds really boring, but this is actually really important to support the change you want to make. Sometimes this is called an audit but essentially you want to collect some information on cases; we want to be able to compare the current protocol to our proposed new protocol. One method of doing this is collecting cases of the same condition – for example, diarrhea – and then using the old protocol (ie. Chicken and rice) for a subset of those cases, and the new protocol (ie. Probiotics and GI food) with another subset. You may also use this phase to ask your team what outcomes they’ve seen and any stumbling blocks they may have when trialling or implementing the new protocols. Tips to get started:

• What are the common conditions you see in practice and what are your current recommendations?

• Does the current evidence support these recommendations?

• In what ways could we do better?

• What are the outcomes of these recommendations? Try and take an objective look at how patients do after these recommendations – perhaps do an audit as mentioned above

Step Three – Consider Alternatives:

Now that you have the data and the cases to support your change, now you need to think about the alternative protocol you want to implement. Like with training a dog, you don’t punish the bad behaviour – you instead reinforce the preferred behaviour, giving them an alternative choice. It’s harder to stop doing something all together, it’s easier to instead offer a replacement that still solves the problem and has a better outcome than the original choice. Some tips to get started:

• Using the case information and data collected, which group of patients had a better outcome?

• Would an alternative product recommendation improve the situation? Does an alternative product exist?

• Does the research give us an alternative to use?

• You may want to conduct a trial of your alternative protocol and use this to form part of your petition

Step Four – Presentation:

You now need to present this information to your team and/or management. Change is hard! Be prepared for any potential pushback and try to anticipate any concerns or reservations they may have about changing. Bring with you all your research, data collected and any results of trials you’ve conducted. Present the information in an easy to understand format. Some ideas on presenting:

• Target their main reservations about changing their protocols
– why do they do things in this way? Have they considered other alternatives before and what was the outcome? How will you prevent history repeating itself?

• Bring with you some evidence; why will this alternative be better, how will it improve outcomes, if you conducted a trial, what were the results?

• How will you present to your team? At a staff meeting? Lunch and learn? Meeting with management?

• How will we determine success? How will we measure that this is better? Will you look at patient outcomes? Will you speak to your team as to how recommendations have changed?

• Organise a follow up meeting a few weeks after the protocol has been implemented to discuss and problem solve any issues or roadblocks that arise

So there you have it! Some pointers on how to get started in pitching a new nutrition protocol in your practice and changing outdated treatments. Did this post give you ideas? What will you change in your clinic? Leave a comment below!