Advertisement

Educational, Recording and Organizational Interventions Regarding Critical Care Nutritional Support

  • Andrés Luciano Nicolas Martinuzzi
  • Sergio Santana Porben
  • Eduardo Ferraresi
  • Víctor Hugo Borrajo
  • Victor R. Preedy
Reference work entry

Abstract

Medical practice is not exempted from complications. This is particularly relevant in the critical care setting. Decisions bearing on patient’s lives have to be taken amidst tensions dictated by windows of opportunity, progression of the disease, and availability of technological equipment and staff. In spite of all of these factors, medical errors can arise. Critical care medicine has gone through an evolutionary threshold in the last few decades, thanks to the works of dedicated researchers such as Amato, Van de Bergher, and Rivers, among others. The international community has developed several initiatives to implement their findings and recommendations. It is however disturbing that nutritional support has not received equal attention as the advances in medical science. This is also reflected in the education of medical students in some countries where nutrition as a specialist subject is rather brief. All this should be considered with respect to evidence-based data which strengthens the notion that nutritional support generates superior medical care outcomes.

To ensure optimal care of the patient, a quality control system relating to nutritional support should be designed and put into effect. This involves strengthening the documentation around the nutritional support protocol, which must be harmoniously integrated into continuing education programs. Proper documentation also serves to evaluate the effectiveness of nutritional and metabolic interventions and has a potential impact on hospital management. In this regard, educative and organizative interventions must be conducted on three levels: (1) increasing the knowledge base of medical and paramedical personnel about current nutritional support practices in the intensive care unit, (2) better documentation and recording practices, and (3) continuous training and education.

Adopting these aforementioned procedures will result in a higher fulfillment of nutritional prescriptions, an increased coverage of patients prescribed with nutritional support, and a higher proportion of patients receiving the prescribed energy.

Keywords

Intensive Care Unit Parenteral Nutrition Medical Error Nutritional Support Standard Operating Procedure 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

List of Abbreviations

ICU

Intensive care unit

ISO

International Organization for Standardization

NS

Nutritional support

PN

Parenteral nutrition

PRINUMA

Food, Nutritional, and Metabolic Intervention Program

SGA

Subjective Global Assessment

SOP

Standard Operating Procedure

References

  1. Anónimo. ISO 9000 quality management. Quinta Edición. Ginebra: International Organization for Standardization; 1994.Google Scholar
  2. August DA. Creation of a specialized nutrition support outcomes research consortium: if not now, when? JPEN J Parenter Enteral Nutr. 1996;20:394–400.CrossRefPubMedGoogle Scholar
  3. August DA, Serrano D. Outcomes research in specialized nutrition support. Nutr Clin Pract. 2007;22:602–8.CrossRefPubMedGoogle Scholar
  4. Bates DW, Larizgoitia I, Prasopa-Plaizier N, Jha AK. Global priorities for patient safety research. Br Med J. 2009;338:1242–4.CrossRefGoogle Scholar
  5. Benya R, Layden TJ, Mobarhan S. Diarrhea associated with tube feeding: the importance of using objective criteria. J Clin Gastroenterol. 1991;13:167–72.CrossRefPubMedGoogle Scholar
  6. Berte L, Nevalainen DE. Writing standard operating procedures. Lab Med. 1996;27:514–6.CrossRefGoogle Scholar
  7. Berwick DM, Calkins DR, McCannon CJ, Hackbarth AD. The 100 000 lives campaign. JAMA. 2006;295:324–7.CrossRefPubMedGoogle Scholar
  8. Bohnker BK, Artman LE, Hoskins WJ. Narrow bore nasogastric feeding tube complications. Nutr Clin Pract. 1987;2:203–9.Google Scholar
  9. Brennan TA, Leape LL, Laird NM, Hebert L, Localio AR, Lawthers AG, et al. Incidence of adverse events and negligence in hospitalized patients: results of the Harvard Medical Practice Study I. N Engl J Med. 1991;324:370–6.CrossRefPubMedGoogle Scholar
  10. Cannonn PR, Wissler RW, Woolridge RL, Benditt EP. The relationship of protein deficiency to surgical infection. Ann Surg. 1944;120:514–25.CrossRefGoogle Scholar
  11. Correia MITD, Campos ACL. Prevalence of hospital malnutrition in Latin America: the multicenter ELAN Study. Nutrition. 2003;19:823–5.CrossRefPubMedGoogle Scholar
  12. David G, et al. Economic measurement of medical errors using a hospital claims database. Value Health. 2013;16(2):305–10.CrossRefPubMedGoogle Scholar
  13. Dellinger RP, Levy MM, Carlet JM, Bion J, Parker MM, Jaeschke R, et al. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2008. Intensive Care Med. 2008;34:17–60.CrossRefPubMedGoogle Scholar
  14. Donaldson L, Didier P. Challenging the world: patient safety and health care-associated infection. International Journal for Quality in Health Care 2006;18(1):4–8.CrossRefPubMedGoogle Scholar
  15. Fernández Ortega JF, Herrero Meseguerb JI, Martínez García P. Guidelines for specialized nutritional and metabolic support in the critically-ill patient. Update. Consensus SEMICYUC-SENPE. Chapter 2: indications, timing and routes of nutrient delivery. Nutr Hosp. 2011;26 Suppl 2:7–11.PubMedGoogle Scholar
  16. Ferraresi Zarranz EM. Complicaciones infecciosas en la Nutrición parenteral. ITAES. 2008;10:20–33.Google Scholar
  17. Freijer K, Tan SS, Koopmanschap MA, Meijers JMM, Halfens RJG, Nuijten MJC. The economic costs of disease related malnutrition. Clin Nutr. 2013;32:e136–41.CrossRefGoogle Scholar
  18. Gallagher-Allred CH, McCamish MA, Coble Voss A. Desnutrición: Un costo oculto en los servicios de salud. In: Sproat KV, Russell CM, editores. Chicago: Ross Products Division, Abbott Laboratories; 1996.Google Scholar
  19. Grimshaw J, Campbell M, Eccles M, Steen N. Experimental and quasi-experimental designs for evaluating guideline implementation strategies. Fam Pract. 2000;17:S11–8.CrossRefPubMedGoogle Scholar
  20. Hunter TB, Fon GT, Silverstein ME. Complications of intestinal tubes. Am J Gastroenterol. 1981;76:256–61.PubMedGoogle Scholar
  21. James J. A New, Evidence-based estimate of patient harms associated with hospital care. J Patient Saf. 2013;9:122Y128CrossRefGoogle Scholar
  22. Kohn LT, Corrigan JM, Donaldson MS. To err is human: building a safer health system, vol. 627. Washington, DC: National Academies Press; 2000. p. 20–5.Google Scholar
  23. Leape LL, Brennan TA, Laird N, Lawthers AG, Localio AR, Barnes BA, et al. The nature of adverse events in hospitalized patients: results of the Harvard Medical Practice Study II. N Engl J Med. 1991;324:377–84.CrossRefPubMedGoogle Scholar
  24. Localio AR, Lawthers AG, Brennan TA, Laird NM, Hebert LE, Peterson LM, et al. Relation between malpractice claims and adverse events due to negligence: results of the Harvard Medical Practice Study III. N Engl J Med. 1991;325:245–51.CrossRefPubMedGoogle Scholar
  25. López Martín C, Abilés J, Garrido Siles M, Faus Felipe V. Impacto de la creación de un equipo de soporte nutricional en la calidad, seguridad y efectividad de la nutrición parenteral. Nutr Hosp. 2012;27:871–8.PubMedGoogle Scholar
  26. Martinuzzi A, Ferraresi E, Orsatti M, et al. Estado del soporte nutricional en una unidad de Cuidados críticos. RNC. 2011;20:5–17.Google Scholar
  27. Martinuzzi A, Ferraresi E, Orsati M, Palaoro A, Chaparro J, Alcántara S, Amin C, Feller C, Di Leo ME, Guillot A, García V. Impacto de un proceso de mejora de la calidad en el estado del soporte nutricional en una unidad de cuidados intensivos. Nutr Hosp. 2012;27:1219–27.PubMedGoogle Scholar
  28. McClave SA. Managing complication of percutaneous and nasoenseric feeding tubes. Techn Gastrointest Endosc. 2001;3:62–8.CrossRefGoogle Scholar
  29. Miquet Romero LM, Rodríguez Garcell R, Barreto Penié J, Santana Porbén S. Estado de la provisión de cuidados nutricionales al paciente quemado. Auditoría de procesos en un Servicio de Quemados de un hospital terciario. Nutr Hosp. 2008;23:354–65.PubMedGoogle Scholar
  30. Penié JB, González CM, Porbén SS. Programa de Intervención Alimentaria, Nutrimental y Metabólica. RCAN Rev Cubana Aliment Nutr. 1999;13:137–44.Google Scholar
  31. Pimiento de Echeverri S. Curso CINC Interdisciplinario de Nutrición Clínica. FELANPE Federación Latinoamericana de Nutrición clínica, Terapia Nutricional y Metabolismo. Segunda Edición. Sao Paulo, Federation of enteral and parenteral nutritional support (FELAMPE), 2010.Google Scholar
  32. Samransamruajkit S, et al: Clinical outcomes after utilizing surviving sepsis campaign in children with septic shock and prognostic value of initial plasma NT-proBNP. Indian J Crit Care Med. 2014;18(2):70–76.CrossRefPubMedPubMedCentralGoogle Scholar
  33. Santana Porbén S. Sistema de Documentación y Registros. Su lugar dentro de un programa de Intervención Alimentaria, Nutrimental y Metabólica. Nutr Hosp. 2005;20:331–42.PubMedGoogle Scholar
  34. Santana Porbén S. La desnutrición hospitalaria: ¿Mal inherente a los sistemas actuales de salud, y/o próximo reto a vencer? RNC. 2009;18:5–17.Google Scholar
  35. Santana Porbén S. Sistema de Control y Aseguramiento de la Calidad. Su lugar dentro de un programa de intervención alimentaria, nutrimental y metabólica. Nutr Hosp. 2012;27:894–907.PubMedGoogle Scholar
  36. Santana Porbén S, Barreto Penié J. Programa de Intervención en Nutrición hospitalaria: Acciones, diseño, componentes, implementación. Nutr Hosp. 2005;20:351–7.PubMedGoogle Scholar
  37. Santana Porbén S, Barreto Penié J. Sistema de Educación Continuada en Nutrición Clínica, Nutrición Artificial y Apoyo Nutricional; su lugar dentro de un Programa de Intervención Alimentaria, Nutricional y Metabólica. Nutr Hosp. 2009;24:548–57.PubMedGoogle Scholar
  38. Santana Porbén S, Cuban Group for the Study of Hospital Malnutrition. The state of the provision of nutritional care to hospitalized patients – results from The ELAN-Cuba Study. Clin Nutr. 2006;25:1015–29.CrossRefGoogle Scholar
  39. Santana Porbén S, Ferraresi E. La Epidemiología de la Desnutrición hospitalaria. RNC. 2009;18:101–17.Google Scholar
  40. Santana Cabrera L, O’Shanahan Navarro G, García Martul M, Ramírez Rodríguez A, Sánchez Palacios M, Hernández Medina E. Calidad del soporte nutricional artificial en una unidad de cuidados intensivos. Nutr Hosp. 2006;21:661–6.PubMedGoogle Scholar
  41. Sitzmann JV, Townsend TR, Siler MC, Barlett JG. Septic and technical complication of central venous catheterization. A prospective study of 200 consecutive patients. Ann Surg. 1985;202:766–70.CrossRefPubMedPubMedCentralGoogle Scholar
  42. Sriram K, Hammond J. Leakage of feedings and gastric contents through ostomy sites. JPEN J Parenter Enteral Nutr. 1986;10:437.CrossRefPubMedGoogle Scholar
  43. Vincent J-L. Give your patient a fast hug (at least) once a day. Critical Care Med. 2005;33:1225–9.CrossRefGoogle Scholar
  44. Waitzberg DL, Correia MI, Echenique M, Ize Lamache L, Soto JK, Mijares JM, et al. Total nutritional therapy: a nutrition education program for physicians. Nutr Hosp. 2004;19:28–33.PubMedGoogle Scholar
  45. Windsor JA, Hill GL. Weight loss with physiologic impairment. A basic indicator of surgical risk. Ann Surg. 1988;207:290–6.CrossRefPubMedPubMedCentralGoogle Scholar
  46. Zimmaro DM, Guenter PA, Settle RG. Defining and reporting diarrhea in tube fed patients- what a mess! Am J Clin Nutr. 1992;55:753–9.Google Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Andrés Luciano Nicolas Martinuzzi
    • 1
  • Sergio Santana Porben
    • 2
  • Eduardo Ferraresi
    • 3
  • Víctor Hugo Borrajo
    • 4
  • Victor R. Preedy
    • 5
  1. 1.Critical CareCentro Medico Integral del Comahue, Unidad de Cuidados CríticosNeuquénArgentina
  2. 2.Instituto de GastroenterologiaLa HabanaCuba
  3. 3.Unidad de Cuidados Críticos, HIGA, Hospital Interzonal General de Agudos Dr. Rodolfo RossiLa PlataArgentina
  4. 4.Terapia IntensivaCentro Medico Integral del Comahue, (CMIC)NeuquenArgentina
  5. 5.Department of Nutrition and Dietetics, Division of Diabetes and Nutritional SciencesFaculty of Life Sciences and Medicine, King’s College LondonLondonUK

Personalised recommendations