[Cnm] Ireton-Jones formula

Sandra Beil SBeil at eatright.org
Wed Aug 26 15:08:30 PDT 2009

The ADA Nutrition Care Manual® uses this formula as well when I chose ICU and burns as factors. If you use the NCM, check the main calculators page. Here is the reference:

Ireton-Jones, 1992 Equations2 (5): 
Spontaneously breathing Ireton-Jones Energy Equation (s) = 629 - 11 (A) + 25 (W) - 609 (O) 

Ventilator dependent Ireton-Jones Energy Equation (v) = 1925 - 10 (A) + 5 (W) + 281 (S) + 292 (T) + 851 (B)     

Equations include age (A) in years, body weight (W) in kilograms (kg), sex (S, male = 1, female = 0), diagnosis of trauma (T, present = 1, absent = 0), diagnosis of burn (B, present = 1, absent = 0), obesity >30% above initial body weight from 1959 Metropolitan Life Insurance tables or Body Mass Index > 27 (present = 1, absent = 0).

5.  Ireton-Jones CS, Turner WW, Leipa GU, Baxter, CR.  Equations for estimation of energy expenditures in patients with burns with special reference to ventilatory status.  Journal of Burn Care and Rehabilitation 1992;13:330-333.

Sandra D. Beil
Nutrition Care Manual® Sales Manager
American Dietetic Association
120 South Riverside Plaza, Suite 2000
Chicago, Illinois 60606-6995
Direct:  312-899-4795
Fax: 312-899-5339
Toll Free: 800-877-1600 x4795

-----Original Message-----
From: cnm-bounces at lists.my180.net [mailto:cnm-bounces at lists.my180.net] On Behalf Of Jennifer Currey
Sent: Wednesday, August 26, 2009 12:56 PM
To: 'cnm at lists.my180.net'; Debra J Jeske
Subject: Re: [Cnm] Ireton-Jones formula

I agree, what a crazy situation.  Correct me if I am wrong, but aren't text books based on literature and results of studies in the pertinent area???   Have them just look at the reference list for the ADA Manual of Dietetics.  
I think you would have a revolt of dietitians if you really got cited on this. Please let us all know your outcome.  

And, for real, how much of a difference can there be between formulas and what the patient is ACTUALLY eating!!!  
ps- i do know that there is a difference in the formulas, i just think in the grand scheme, why is what she used a bad choice-  was there patient harm?????? if not, then what is the problem.....  

Jennifer Currey RD,LDN
University Specialty Hospital
Clinical Nutrition Manager
410-547-8500  Ext:545
Cell: 410-409-3614

>>> "Jeske, Debra J" <Debra.Jeske at stlukes-stl.com> 8/26/2009 1:28 PM >>>
We are in the process of a CMS survey.  One of our dietitians documented in her note she had used the Ireton-Jones formula to assess calorie needs.  The surveyor stated this was an experimental formula.  We need to provide documentation that it is cited in textbooks (no journal articles) and show that it is an accepted practice.  If we are unable to do so, the surveyor indicates she will cite us on using experimental data and not getting informed consent from the patient to use that formula to estimate their needs.  I would like to hear back from facilities who occasionally or  routinely use this as an assessment tool.  Our dietitians frequently will look at multiple equations and compare to see if what they are recommending makes "sense" using their clinical judgement of the individual patient.

In addition to the above, I would also like to hear what criteria you are using for your initial admission screen.  Currently nursing does our screening.  Results are entered into the EMR.  Answering yes to any of the nutritional risk factors automatically triggers a nutrition consult (no nursing action to put consult in).  In addition, the computer generates automatic consults for a BMI <19.

Nutritional Risk Factors
        Have you lost weight recently without trying?
        Impaired nutritional intake for >10 days?
        Stage 3 or 4 skin breakdown

We do not use labs, diagnosis or diet order as part of the admission nutrition screen.  Our policy is to see all consults within 48 hours (usually 24 hours but have 48 to accommodate being on call on Sunday).  Rescreening is completed by day 7.  Tube Feedings and TPN patients are seen at least every 3 days until stable.

I would like to hear how our practices compare to others.  I know this was discussed on the list previously and have reviewed that information but am looking for an update.  Thanks in advance.

Debbie Jeske, MS, RD, LD, CNSD
Manager, Clinical Nutrition and Patient Services
St. Luke's Hospital
232 S. Woods Mill Rd.
Chesterfield, MO  63017
Phone  314-205-6975
Beeper 314-855-7048
debra.jeske at stlukes-stl.com 

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