Overview of Additional Medical Fees for NSTs
Additional medical fees for NSTs are used to recognize the medical care provided by multidisciplinary teams made up of physicians, registered nurses, pharmacists, and registered dietitians who have expertise in nutrition management, in order to improve the quality of life of patients with nutritional disorders or patients at high risk of developing nutritional disorders, promote the healing of the underlying disease, and prevent complications such as infections.
Requirements for Calculating Additional Medical Fees for NSTs
(1) Nutrition-related meetings and hospital rounds for eligible patients (about once a week)
(2) Formulation of nutritional treatment implementation plans for eligible patients, and medical care provided by the team based on these plans
(3) No more than 30 patients per day per team
Institutional Standards regarding Additional Medical Fees for NSTs
A team for nutrition management made up of the specified full-time specialists described in (1) to (4) below must be established within the relevant medical institution providing services covered by health insurance. In addition, one of these specialists must be assigned exclusively to this position. However, if the number of patients seen by the relevant support team is no more than 15 per day, an exclusive assignment is not required.
(1) Full-time physician who has completed the required training in nutrition management
(2) Full-time registered nurse who has completed the required training in nutrition management
(3) Full-time pharmacist who has completed the required training in nutrition management
(4) Full-time registered dietitian who has completed the required training in nutrition management
In addition to the above, it is preferable that dentists, dental hygienists, clinical laboratory technicians, physical therapists, occupational therapists, certified social workers, and speech therapists are also available.
Training Requirements for NST Physicians and Medical Staff
(1) NST Physicians
In order to develop physicians with specialized knowledge and skills regarding nutrition management, the training in nutrition management that is required for physicians should cover at least 10 hours and should be conducted by a medical organization. This training should cover the following content.
(i) Effects of malnutrition
(ii) Nutrition assessment methods and nutrition screening
(iii) Selection of nutrition delivery routes and nutrition management planning
(iv) Implementation of total parenteral nutrition, as well as its complications and countermeasures
(v) Implementation of peripheral parenteral nutrition, as well as its complications and countermeasures
(vi) Implementation of enteral nutrition, as well as its complications and countermeasures
(vii) Methods of operation and practical activities for nutrition support teams
(2) NST Medical Staff
The training in nutrition management that is required for the three positions other than physician should include the following.
- The training program must be conducted at an educational facility accredited by a medical organization, etc. and require at least 40 hours. Upon completion, participants should receive a certificate of completion issued by the organization.
- The training program should be designed to train registered nurses, pharmacists, and registered dietitians with specialized knowledge and skills for nutrition management. This training should cover the following content.
(i) Identification of and early response to nutritional disorders (screening method)
(ii) Guidance regarding the selection and proper use of nutritional drugs, nutritional solutions, and food
(iii) Methods for administering parenteral nutritional supplements through a side tube, and calling attention to changes in the chemical composition
(iv) Obtaining the proper dispensing method for parenteral solutions
(v) Planning and monitoring of parenteral nutrition
(vi) Guidance regarding hygiene management and proper dispensing methods for enteral nutritional supplements
(vii) Planning and monitoring of enteral and oral nutrition
(viii) Implementation and Understanding the usefulness of the simple suspension method
(ix) Prevention of complications related to nutritional therapy, and handling of complications when they occur
(x) Identification of problems and risks related to nutritional therapy
(xi) Explanation and guidance to patients and families regarding nutritional management
(xii) Guidance regarding nutrition at home and nutrition management methods at non-medical facilities