Nutrition support practices in South African ICUs: Results from a nationwide pilot survey

Abstract

Background. Nutrition support of the critically ill can positively affect clinical outcomes. International audit data of nutrition practices in intensive care units (ICUs) suggest that inconsistent application of recommended nutrition support practices (NSPs) occurs. There are no data on NSPs in South African (SA) ICUs. Objective. To perform a national pilot survey of NSPs in private SA adult ICUs. Methods. A descriptive, observational, cross-sectional survey was performed among prescribers of nutrition support in private ICU facilities. Participants were targeted through non-randomised convenience sampling and invited to complete a 51-item electronic questionnaire covering ICU demographics, profile of nutrition prescribers, and nutrition assessment support, delivery and monitoring practices. Results. Responses were received from 125 practitioners in 60% of representative private hospitals with ICU facilities, mainly general/ mixed ICUs. Forty-six percent of respondents reported structured nutrition support teams and 61% reported that practices were governed by formal nutrition support protocols. Enteral nutrition was reported to be based upon published guidelines by 72% of dietitians, while parenteral nutrition decisions were reportedly based mainly on clinical judgement (43%). For both enteral and parenteral feeding practices, compliance with guidelines was inconsistent. There was a disjuncture between various NSPs as reported by dietitians and by nurses. Nurses generally appeared unaware of published nutrition guidelines. Conclusion. Various disparities in reported nutrition practices were revealed, suggesting that the organisation and operations of teams and the implementation of protocols informed by published nutrition guidelines may not be well established in private SA ICUs.

Nutrition support practices in the intensive care unit of a tertiary hospital in Ghana

“…The Hill Questionnaire [5] was adapted and modified for this study. Hill's study evaluated nutrition support practices with sub-themes on nutrition screening and assessment, nutrition decision-making, enteral nutrition delivery, administration and monitoring; parenteral nutrition delivery, administration and monitoring; and the types of nutrition products used.…”

“…[3] Studies have revealed that attenuation of the catabolic effects of critical illness is associated with improved outcomes in the intensive care unit (ICU). [4,5] Despite the benefits of medical nutrition therapy in the ICU, optimal nutrition approaches remain a challenge. [1,3,6] One of the challenges in achieving optimal nutrition support is variations in actual clinical nutrition practices [4,5,7] delivered to ICU patients.…”

“…[4,5] Despite the benefits of medical nutrition therapy in the ICU, optimal nutrition approaches remain a challenge. [1,3,6] One of the challenges in achieving optimal nutrition support is variations in actual clinical nutrition practices [4,5,7] delivered to ICU patients. Implementation and adherence to nutrition support practice guidelines may not be as easy as it seems [5] and nutrition support is often overlooked in critical cases.…”

“…[1,3,6] One of the challenges in achieving optimal nutrition support is variations in actual clinical nutrition practices [4,5,7] delivered to ICU patients. Implementation and adherence to nutrition support practice guidelines may not be as easy as it seems [5] and nutrition support is often overlooked in critical cases. [8] Some of the factors contributing to the reduced implementation of nutrition support guidelines include a high workload, resistance to change, lack of awareness, lack of knowledge, lack of critical care experience, complex patient conditions, inadequate resources, obstructive administrative processes, lack of evidence, or outdated guidelines.…”

Perceived Potential Barriers to Implementation of Nutritional Therapy Practice Guidelines in Critically Ill Adults in a District of KwaZulu-Natal, South Africa

“…A nation-wide pilot study that surveyed nutritional support practices in private South African (SA) adult intensive care units (ICUs) revealed disparities in reported nutrition practices, suggesting among other things, that implementation of published nutrition guidelines was not well established (Hill, 2015). That was before the establishment of the SA national enteral nutrition practice guidelines for adults, which make provision for adult patients in need of EN at all levels of public healthcare and in their households (home-based enteral nutritional therapy).…”