A PA Research Foundation funded study is changing the way nutrition is delivered to liver transplant patients, with the goal of speeding up healing and recovery and ultimately improving outcomes.
As the leading hospital for liver transplant surgeries in Queensland, the enhanced recovery after surgery liver transplant nutrition research by dietitian Tahnie Takefala and her colleagues in the metabolic research group is set to benefit all people receiving a transplant at PA Hospital.
The research project focuses on the benefits of initiating nutrition early after transplant surgery and transitioning without delay to a high protein and high energy diet in the initial post-operative stage. Commencing nutrition can be considered as soon as the patient arrives in ICU after surgery. Early initiation of nutrition has been shown to benefit healing and recovery.
“There is a lot of work being done to improve nutritional status prior to liver transplant but this particular project kindly supported by the Foundation is about improving nutrition care for patients in the early stages after transplant,” Tahnie said.
“We are hoping to improve both their outcomes and experiences. We know that getting good nutrition before and after a liver transplant surgery is beneficial for our patients and the evidence supports the key role nutrition plays in healing and recovery and in getting our patients back to their normal lives as quickly as possible.
“The PA Hospital cares for all liver transplant recipients from across the state, and what we are trying to do is investigate the best possible ways to give evidence-based nutrition care to these people who receive the precious gift of a new liver and essentially a new life.”
Tahnie’s project, which is currently in the implementation stage, involved auditing current nutrition practices after liver transplant surgery, followed by interviewing healthcare staff involved in post-transplant care including surgeons, hepatologists, intensivists and nursing staff to understand what influences decisions around initiating nutrition after surgery. In consultation with Surgeons, who are the key decision makers around timing of nutrition initiation, Tahnie developed a post-operative nutrition protocol and provided staff education to support the roll out of post-operative nutrition care protocols after liver transplant.
“Our findings show there are a number of different factors that impact on how a patient will receive nutrition care after their transplant. It is not just as simple as having a protocol to follow, there are lots of different influences and different people involved in the care of someone after they leave the operating theatre,” she said.
“The surgeon is integral to delivering early post-operative care, but there is also the nursing staff, the medical staff and the dietitians all working together to make nutrition decisions to help patients recover during that time period.
PA Hospital Dietitian Tahnie Takefala.
“Integrating and collaborating with all of these team members and advocating for nutrition is vital. The funding we have received has allowed us to foster that multidisciplinary collaboration, and bring nutrition to the front of mind during complex surgical recovery.”
The early feeding protocol agreed to by the treating team and implemented in this project aligns with established evidence to commence nutritional fluids early after surgery and to commence high energy and high protein foods within the first 24 hours when there are no contraindications.
“We want to avoid patients remaining ‘nil by mouth’ after surgery, and they can commence nutritional drinks as soon as possible and build up to normal food (or food through a tube if they are not able to eat), within that first day of surgery. Our project is looking at ways the hospital system can facilitate good nutrition in that post op period,” Tahnie said.
“This project has challenged some traditional practices of delaying nutrition or starting slowing on clear fluids only. The protocol implementation advocates for commencing nutritional fluids early, and when there is no contraindication, to build intake up to normal food as quickly as possible, ideally by the next meal which could be the evening meal of the day of surgery.”
Tahnie said the ongoing support from both Peter Hodgkinson (the Acting Director of the Queensland Liver Transplant Service) and the Foundation for dietetics research is greatly valued and appreciated by herself and her colleagues.
“PA Foundation has supported the metabolic research team for a number of years including this current project. That support not only helps health professionals like me build skills and confidence to undertake research, but it’s helped enable the entire metabolic program to improve the patient journey overall and hopefully led to improved outcomes for liver transplant recipients,” she said.
“The Foundation has been vital in empowering us to implement the best possible and evidence-based nutrition care for liver transplant patients and in turn improving their experience throughout the liver transplant journey.”
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