[Impact of quality improvement process upon the state of nutritional support in a critical care unit]. / Impacto de un proceso de mejora de la calidad en el estado del soporte nutricional en una unidad de cuidados intensivos.

INTRODUCTION: In a preceding article the state of Nutritional support (NS) in an Intensive Care Unit (ICU) was documented [Martinuzzi A et al. Estado del soporte nutricional en una unidad de Cuidados críticos. RNC 2011; 20: 5-17]. In this follow-up work we set to assess the impact of several organizational, recording and educational interventions upon the current state of NS processes. MATERIALS AND METHODS: Interventions comprised presentation of the results of the audit conducted at the ICU before the institution's medical as well as paramedical personnel; their publication in a periodical, peer-reviewed journal; drafting and implementation of a protocol regulating NS schemes to be carried out at the ICU; and conduction of continuous education activities on Nutrition (such as "experts talks", interactive courses, and training in the implementation of the NS protocol). The state of NS processes documented after the interventions was compared with the results annotated in the preceding article. Study observation window ran between March the 1st, 2011 and May 31th, 2011, both included. RESULTS: Study series differed only regarding overall-mortality: Phase 1: 40.0% vs. Phase 2: 20.5%; Difference: 19.5%; Z = 1.927; two-tailed-p = 0.054. Interventions resulted in a higher fulfillment rate of the prescribed NS indication; an increase in the number of patients receiving ≥ 80% of prescribed energy; and a reduction in the number of NS lost days. Mortality was (numerically) lower in patients in which the prescribed NS scheme was fulfilled, NS was early initiated, and whom received ≥ 80% of prescribed energy. Adopted interventions had no effect upon average energy intakes: Phase 1: 574.7 ± 395.3 kcal/24 h⁻¹ vs. Phase 2: 591.1 ± 315.3 kcal/24 h⁻¹; two-tailed-p > 0.05. CONCLUSIONS: Educational, recording and organizational interventions might result in a better conduction of NS processes, and thus, in a lower mortality. Hemodynamic instability is still the most formidable obstacle for initiating and completing NS.

Impacto de un proceso de mejora de la calidad en el estado del soporte nutricional en una unidad de cuidados intensivos / Impact of quality improvement process upon the state of nutritional support in a critical care unit

Introducción: En un artículo precedente se documentó el estado del Soporte nutricional (SN) en una Unidad de Terapia Intensiva (UTI) [Martinuzzi A y cols. Estado del soporte nutricional en una unidad de Cuidados críticos. RNC 2011; 20: 5-17]. En este trabajo de seguimiento nos propusimos evaluar el impacto de varias intervenciones educativas, registrales y organizativas hechas en la Unidad sobre el estado actual de los procesos del SN. Material y método: Las intervenciones incluyeron la presentación de los resultados de la auditoría hecha en la UTI ante el plantel médico y paramédico de la institución; la publicación de los mismos en una revista periódica, arbitrada por pares; la redacción e implementación de un protocolo normativo de los esquemas de SN a conducir en la UTI; y la celebración de actividades de educación continuada en Nutrición (como "charlas con expertos", cursos interactivos, y capacitación en la implementación del protocolo de SN). El estado de los procesos de SN documentado tras las intervenciones se comparó con los resultados anotados en el trabajo precedente. La ventana de observación del estudio se extendió entre el 1 de Marzo del 2011 y el 31 mayo del 2011, ambos incluidos. Resultados: Las series de estudio difirieron entre sí solo respecto de la mortalidad: Fase 1: 40.0% vs. Fase 2: 20,5%; Diferencia: 19,5%; Z = 1,927; p-de-2-colas = 0,054. Las intervenciones hechas resultaron en una mayor tasa de cumplimiento de la indicación prescrita de SN; un aumento en el número de enfermos que recibieron > 80% de la energía prescrita; y una reducción en el número de días de SN perdidos. La mortalidad fue (numéricamente) menor en los pacientes en los que se cumplió el esquema prescrito de SN, el SN se inició tempranamente, y que recibieron > 80% de la energía prescrita. Las intervenciones adoptadas no tuvieron efecto sobre los aportes promedio de energía: Fase 1: 574,7 ± 395,3 kcal/24 h-1 vs. Fase 2: 591,1 ± 315,3 kcal/24 h-1; p > 0,05. Conclusiones: Las intervenciones educativas, registrales y organizativas pueden resultar en una mejor conducción de los procesos de SN, y con ello, en una menor mortalidad. La inestabilidad hemodinámica sigue siendo el obstáculo más formidable en el inicio y mantenimiento del SN (AU)

Introduction: In a preceding article the state of Nutritional support (NS) in an Intensive Care Unit (ICU) was documented [Martinuzzi A et al. Estado del soporte nutricional en una unidad de Cuidados críticos. RNC 2011; 20: 5-17]. In this follow-up work we set to assess the impact of several organizational, recording and educational interventions upon the current state of NS processes. Materials and methods: Interventions comprised presentation of the results of the audit conducted at the ICU before the institution's medical as well as paramedical personnel; their publication in a periodical, peerreviewed journal; drafting and implementation of a protocol regulating NS schemes to be carried out at the ICU; and conduction of continuous education activities on Nutrition (such as "experts talks", interactive courses, and training in the implementation of the NS protocol). The state of NS processes documented after the interventions was compared with the results annotated in the preceding article. Study observation window ran between March the 1st, 2011 and May 31th, 2011, both included. Results: Study series differed only regarding overallmortality: Phase 1: 40.0% vs. Phase 2: 20.5%; Difference: 19.5%; Z = 1.927; two-tailed-p = 0.054. Interventions resulted in a higher fulfillment rate of the prescribed NS indication; an increase in the number of patients receiving > 80% of prescribed energy; and a reduction in the number of NS lost days. Mortality was (numerically) lower in patients in which the prescribed NS scheme was fulfilled, NS was early initiated, and whom received > 80% of prescribed energy. Adopted interventions had no effect upon average energy intakes: Phase 1: 574.7 ± 395.3 kcal/24 h-1 vs. Phase 2: 591.1 ± 315.3 kcal/24 h1; two-tailed-p > 0.05. Conclusions: Educational, recording and organizational interventions might result in a better conduction of NS processes, and thus, in a lower mortality. Hemodynamic instability is still the most formidable obstacle for initiating and completing NS (AU)