6．栄養プロトコル—実践するうえでのTIPS

Nutrition Protocols

栄養プロトコルの必要性は，各国ガイドラインで強調されている。しかし，実際のプロトコル作成と順守は難しい。明確なエビデンスの乏しさや，テーラーメードも要するなか，作成の動機づけを生み，維持することは難しい。まず自施設プロトコルの目標を決め，障壁について多職種で話し合おう。プロトコルには，栄養療法が奏功する患者を絞り込む栄養アセスメントが必須である。有益性が確実そうなものを取り入れ，合併症の発生や有害性を避けるプロトコルを作ってみよう。現時点での各施設の資源，各職種の職能を最大限に活かしたプロトコルで栄養療法の効果を体感しよう。本稿では，自施設の栄養プロトコルを仲間とともに作成し，実践するためのTIPSをお伝えする。

The need for nutritional protocols is highlighted in the nutritional guidelines published in different countries. However, in actuality, few protocols have been created, and compliance with these protocols is complicated by various difficulties. Developing and maintaining the impetus to create such protocols is challenging due to a lack of clear supporting evidence. The protocols must be customized according to their purpose. Facilities must first decide the motivation for the protocols and then discuss barriers to their adoption in an interdisciplinary manner. Nutritional assessment that identifies patients who will potentially benefit from nutritional therapy is essential. We recommend incorporating aspects that are potentially beneficial and devise protocols that avoid complications and mitigate harm. Let us explore the effects of nutritional therapy with protocols that take full advantage of resources available at each facility as well as the characteristics of each job function. I will share various tips that my colleagues and I have found to be helpful while creating and implementing nutritional protocols at our hospital.