The impact of ongoing audit on nutritional support in paediatric intensive care

Meyer, Rosan Waltraut (2004-12)

Thesis (Mnutr)--Stellenbosch University, 2004.

Thesis

ENGLISH ABSTRACT: Objective: To assess the impact of a continuous auditing process on nutritional support in a tertiary paediatric intensive care unit. Design: Prospective, longitudinal audit initiated in 1994. Re-auditing took place almost every 2 years: 1994-1995, 1997-1998 and 2001, leading to completion of the audit cycle. Setting: An 8 bed Paediatric Intensive Care Unit (PICU) in StMary's Hospital London. Subjects: All ventilated patients admitted for more than a complete 24-hour period were included in the audit. The units' standard daily fluid charts were used for data collection. Data was collected until discharge from PICU or a maximum of 10 days. Incomplete and imprecise data was disregarded during the data analysis process. Outcome measures and interventions: The outcome measures include time taken to initiate nutritional support, the route of feeding and delivery of calories by day 3, judged by the Estimated Average Requirements (EAR) for energy. Feeding algorithms and protocols introduced after each audit: nasogastric feeding algorithm following the 1994-1995 audit, blind nasojejunal tube insertion technique and related feeding algorithms after the audit in 1997-1998. Results: Time taken to initiate enteral feeding was reduced from 15 hours (1994- 1995) to 5.5 hours (2001). The proportion of parenterally fed patients fell from 11% (1994-1995) to 1% (200 1 ). The proportion of enterally fed patients via the nasojejunal route rose from 1% (1994-1995) to 20% (2001). An increase was noticed in patients reaching 50% and 70% of energy requirement by day 3 following admission was documented: 7% in1994-1995 to 35% in 2001 for 70% of EAR (p = 0.0008) and 18% in 1994-1995 to 58% in 2001 for 50% of EAR. (p< 0.0001) Conclusion: This audit process demonstrates the effectiveness of continuous auditing in an intensive care unit in improving the quality of nutritional support. This is possible only with a multi-disciplinary team approach.

AFRIKAANSE OPSOMMING: Doel: Om die impak van 'n deurlopende ouditerings proses op die voedingsondersteuning in 'n tersi~re pediatriese intensiewesorg-eenheid te evalueer. · Studie Ontwerp: 'n Prospektiewe, longetudinale oudit is in 1994 geYnisieer. Herouditee·ring het ongeveer elke 2 jaar plaasgevind: 1994-1995, 1997-1998 en 2001. Dit het tot die voltooiing van 'n ouditering siklus gelei. Plek: 'n Agt-bed Pediatriese lntensiewesorgeenheid (PISE) in StMary's Hospitaal London, Engeland. Pasiente: Alle geventilleerde pasiente wat opgeneem was vir !anger as 'n volledige 24 uur-periode is by die oudit ingesluit. Die eenheid se standard daaglikse vogkaarte dokumentasie is gebruik vir data-insameling. Data-insameling het plaasgevind tot en met ontslag vanuit die PISE vir 'n maksimum van 10 dae. Onvolledige en onakkurate data is uitgesluit tydens die data analise proses. Uitkomste en Intervensie: Die uitkomste is gemeet deur die impak van die ouditerings proses te evalueer ten opsigte van tydsduur voordat daar voedings geYnisieer is, die voedingsroete en die hoeveelheid energie gelewer teen dag 3, vergelyk met die geskatte gemiddelde energie behoefte. Voedings-algoritmes en protokolle is geYmplementeer na elke oudit: nasogastriese voedings-algoritmes is na die 1994-1995 oudit geYmplimenteer, 'n blinde nasojejunale buisinplasingstegniek en I relevante voedings algoritmes het na die 1997-1998 oudit gevolg. Resultate: Die tydsduur om voedingondersteuning te inisieer het van 15 ure (1994- 1995) tot 5.5 ure (2001) verminder. Die persentasie pasiente wat parenterale voeding ontvang het, het gedaal van 11% (1994-1995) tot 1% (2001), met 'n toename in enterale voeding via die nasojejunale roete van 1 %(1994) tot 20% (2001). 'n Toename in pasiente wat meer as 50% en 70% van hul energie behoefte bereik het teen dag 3 is opgemerk: 7% in 1994-1995 en 35% in 2001 het meer as 70% van die geskatte gemiddelde behoefte vir energie ontvang. (p=0.0008) Agtien persent het in 1994-1995 en 58% in 2001 meer as 50% van hul gemiddelde energie behoeftes bereik (p < 0.0001). Gevolgtrekking: Hierdie ouditerings proses demonstreer die effektiewiteit van deurlopende ouditering in 'n intensiewesorg-eenheid deur die verbetering van die kwalitiet van voedingondersteuning. Dit is slegs moontlik met 'n multidissiplinere span benadering.

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