Nutrition Quality Control in the Prescription and Administration of Parenteral Nutrition Therapy for Hospitalized Patients

Shiroma, Glaucia Midori; Horie, L.M.; Ribeiro, Mariane Albuquerque Lima; Martins, José Carlos Amado; Bittencourt, Amanda F.; Logullo, L.; Silva, Maria de Lourdes Teixeira da; Waitzberg, Dan Linetzky

doi:10.1177/0884533614567540

Cited by 16 publications

(25 citation statements)

References 36 publications

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“…Similar to some of our results, Shiroma et al 26 found inadequate PN prescriptions in a hospital with an NTT. They also reported that 56.5% of the patients did not receive the calculated nutrition requirements and that the central venous catheter infection rate was high (6 per 1000 catheters per day).…”

Section: Discussionsupporting

confidence: 93%

Implementing Quality Assessment Is Fundamental to Guarantee Optimal Nutrition Therapy

Gomes

Silva

Ferreira

et al. 2019

J Parenter Enteral Nutr

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Introduction The implementation of quality assessment in nutrition therapy (NT) is an important strategy, with the potential to contribute to the reduction of malnutrition and improve the cost‐effectiveness of NT. Studies on this subject are scarce in the world. Our objective was to evaluate the practice of NT in hospitals located in the third‐most‐developed state of Brazil. Methods A cross‐sectional study, using data collected through interviews with members of the clinical staff/interdisciplinary NT team (NTT) and audits of clinical protocols and medical records, was carried out. Both non–probability and probability sampling techniques were used to select the hospitals. Results Thirty‐three hospitals were included (10 public, 10 philanthropic, 9 private, and 4 university). Twenty‐six institutions reported to have an NTT. There was no statistically significant difference in the existence and performance of the teams or in the presence of protocols and quality indicators between the types of hospitals. However, the inspection of 172 medical records showed that essential items for the nutrition care of the patient were not fully in agreement with the previous provided information, and this varied according to the type of hospital. Conclusion The majority of hospitals had an NTT as well as protocols and quality indicators. However, patient records were not in accordance with the essential items to guarantee NT quality and safety, indicating a gap between theory and practice.

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Section: Discussionsupporting

confidence: 93%

Implementing Quality Assessment Is Fundamental to Guarantee Optimal Nutrition Therapy

Gomes

Silva

Ferreira

et al. 2019

J Parenter Enteral Nutr

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“…Shiroma et al (37) showed that the infusion of more than 80% of the caloric needs from PNT led to hospital discharge in ward and ICU patients. The great advantage in PNT, even without gastrointestinal use, is to optimize the supply of energy in the early days of ICU stay, while there is a good metabolic and organic tolerance which can be monitored through routine biochemical tests (38).…”

Section: Quality Indicators For Enteral and Parenteral Nutrition Thermentioning

confidence: 99%

Quality indicators for enteral and parenteral nutrition therapy: application in critically ill patients "at nutritional risk"

Filho¹

2016

Nutr Hosp

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Palabras clave:Indicadores de calidad. Nutrición enteral. Nutrición parenteral. Paciente crítico. Malnutrición. ResumenIntroducción: los indicadores de calidad en terapia nutricional (ICTN) permiten evaluar la calidad de la terapia nutricional (TN) de forma práctica. Objetivo: implementar y monitorizar los ICTN en pacientes críticos con riesgo nutricional. Métodos: estudio transversal con pacientes críticos > 18 años en riesgo nutricional, en terapia nutricional enteral (TNE) o parenteral (TNP) exclusiva a > 72 horas. Después de 3 años consecutivos, 9 ICTN fueron implementados y monitorizados. El análisis estadístico fue realizado con el software SPSS, versión 17.0. Resultados: fueron incluidos 145 pacientes, siendo 93 en TNE, 65% eran de sexo masculino, con edad promedio de 55,7 años (± 17,4); 52 pacientes que estaban en TNP, 67% eran de sexo masculino, con edad promedio de 58,1 años (± 17,4). Todos los pacientes (TNE y TNP) fueron cribados en la admisión, los cálculos de las necesidades calóricas y proteínicas fueron individualizados. Apenas la TNE fue precoz, > 70% del volumen prescrito fue administrado y fue visto una reducida pérdida de la sonda nasoenteral. Las frecuencias de diarrea y ayuno digestivo no fueron adecuadas en TNE. La administración adecuada de energía fue contemplada apenas en TNP y hubo una signifi cativa tendencia de recuperación en la vía oral en TNE. Conclusión: después de 3 años de estudio, el porcentaje de adecuación de los ICTN varió entre 55%-77% para TNE y 60%-80% para TNP. Los resultados refl ejan los esfuerzos del equipo multiprofesional de TN en mantener la calidad de la asistencia nutricional en los pacientes críticos con riesgo nutricional. AbstractIntroduction: Quality Indicators for Nutritional Therapy (QINT) allow a practical assessment of nutritional therapy (NT) quality. Objective: To apply and monitor QINT for critically ill patients at nutritional risk. Methods: Cross sectional study including critically ill patients > 18 years old, at nutritional risk, on exclusive enteral (ENT) or parenteral nutritional therapy (PNT) for > 72 hours. After three consecutive years, 9 QINT were applied and monitored. Statistical analysis was performed with SPSS version 17.0. Results: A total of 145 patients were included, 93 patients were receiving ENT, among then 65% were male and the mean age was 55.7 years (± 17.4); 52 patients were receiving PNT, 67% were male and the mean age was 58.1 years (± 17.4). All patients (ENT and PNT) were nutritionally screened at admission and their energy and protein needs were individually estimated. Only ENT was early initiated, more than 70% of the prescribed ENT volume was infused and there was a reduced withdrawal of enteral feeding tube. The frequency of diarrhea episodes and digestive fasting were not adequate in ENT patients. The proper supply of energy was contemplated only for PNT patients and there was an expressive rate of oral intake recovery in ENT patients. Conclusion: After three years of research, the percentage of QINT adequacy varied be...

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“…56 In a study of PN therapy administration in a hospital, 100 patients who received PN and were under the care of an established NTT for 21 days, or until death or hospital discharge occurred, were examined. 57 The 2007 guidelines for PN according to the A.S.P.E.N. were followed, although PN indications were not in accordance with these guidelines for 15% of the patients examined.…”

Section: Ongoing Challenges In Ntmentioning

confidence: 99%

“…Therefore, despite the existence of a nutrition support team, the quality provision of the PN was not ideal and reinforced the importance of periodic audits and continuous education sessions for every health professional to guarantee the development of appropriate protocols and adequate follow-up. 57 …”

Section: Ongoing Challenges In Ntmentioning

confidence: 99%

Strategies for High‐Quality Nutrition Therapy in Brazil

Waitzberg

Correia

2015

J Parenter Enteral Nutr

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It is a great honor to present the 2015 Rhoads Lecture and to discuss strategies for high-quality nutrition therapy (NT), as well as to address the problem of malnutrition in Brazilian hospitals.Dr Rhoads is known for his outstanding achievements in nutrition care, and his unquestionable legacy is demonstrated by the translation of his many scientific papers and books into several languages. The importance of artificial nutrition in the overall care of a patient is reflected in Dr Rhoads's own words: "intravenous feeding is one of the rare things in Medicine that has turned out to be better than its sponsors anticipated." Moreover, when Dr Rhoads was awarded for his contributions and leadership in the field of nutrition, in his speech, he referred to a quote by Nobel laureate economist Milton Friedman: "success lies on the degree to which one's ideas and contributions become embedded in the body of knowledge that comprised one's discipline."1 Indeed, we are here to confirm the veracity of this statement regarding Dr Rhoads's scientific contributions.Accumulating evidence supports the utmost relevancy of artificial nutrition, including oral nutrition, enteral nutrition (EN), and parenteral nutrition (PN), as one of the cornerstones of patient care. Nonetheless, for the full success of NT to be achieved, it is imperative that standardized procedures be followed to prevent life-threatening associated complications and, above all, to avoid the "one-size-fits-all" practice of nutrition, which should be condemned by those following the evidence behind science. History of NT in BrazilHere, the steps that have helped Brazil implement an NT practice are presented and discussed. The statements herein are based on the experience and data of the authors, although we also acknowledge and cite the work of other professionals who have contributed to the development of NT practice in Brazil. In combination, these scientific data highlight the importance of applying advances in laboratory research to the clinical setting to improve patient care. First, we review the history of clinical nutrition in Brazil, with a particular emphasis on the role of nutrition screening and nutrition assessment as demonstrated by a malnutrition prevalence study that encompassed 4000 patients.2 Next follows a discussion of to whom, when, and what NT should be administered, particularly regarding immunonutrition and parenteral lipid emulsions. Finally, strategies that have been used to implement hospital clinical nutrition are presented, with a focus on patients with short bowel syndrome (SBS) and obesity. The outcomes, costs, quality control, and education in clinical practice that are currently involved with these strategies are also presented, as well as how these strategies have the potential to affect perspectives.Very briefly, Brazil is a country that has approximately 200 million inhabitants, 10% of whom are elderly. Life expectancy AbstractStrategies for improving nutrition therapy (NT) are of utmost importance in any healthcare system. The ...

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Nutrition Quality Control in the Prescription and Administration of Parenteral Nutrition Therapy for Hospitalized Patients

Abstract: Despite an established NST, there was a moderate level of PNT inadequacy in indications, administration, and monitoring. It is important to establish periodic meetings among different health professionals who prescribe and deliver PNT to define responsibilities and protocols.

Cited by 16 publications

References 36 publications

Implementing Quality Assessment Is Fundamental to Guarantee Optimal Nutrition Therapy

Implementing Quality Assessment Is Fundamental to Guarantee Optimal Nutrition Therapy

Quality indicators for enteral and parenteral nutrition therapy: application in critically ill patients "at nutritional risk"

Strategies for High‐Quality Nutrition Therapy in Brazil

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