Applied nutritional investigationNutrition support team activities can improve enteral nutrition administration in intensive care units
Introduction
Enteral nutrition therapy (ENT) is the first treatment line to feed patients on mechanical ventilation or patients at nutritional risk in intensive care units (ICUs) once they cannot rely only on oral nutrition to fulfill their needs [1]. Because of complication risks, ENT is considered a complex therapy and involves high operational costs [2]. Currently, nutrition support teams (NST) are responsible to control ENT quality and all aspects involved in nutritional care, which is determined by law in some countries. The service that regulates NST in accordance with these legal precepts can benefit at the administrative level as well as health care overall [3], [4]
Brazil is one of the first Latin-American countries to develop specific laws for ENT and NST activities [4], [5]. Brazil's National Health Surveillance Agency regulates ENT and determines NST creation in all hospitals that provide ENT to manage this chain of care. NSTs are originally composed of a physician, nutritionist, nurse, pharmacist, and other health professionals at complementary level [5]. NST activities vary according to each hospital's characteristics as well as the human resources available. These teams act by establishing new routines and protocols for nutritional intervention as well as provide direct patient assistance [5], [6]. Given this variety of roles, NST performance can be measured at the patient and administrative levels. This includes nutritional assessment, organizational structure, creation and access to updated protocols, clinical rounds, activities registration, and continual education [7], [8].
In this sense, quality control can be defined as the fulfilment of basic security requirements and processes that guarantee service compliance [9] and comprises the adoption of dynamic, uninterrupted processes that aim to identify flaws in routines and procedures that must be periodically reviewed, updated, and disseminated [10]. This way, ENT quality (defined and evaluated by compliance level with the established standard) should be periodically monitored through audits. Quality indicators are essential components of this evaluation and should reflect the service performance both in clinical and administrative aspects, which demands the use of specific tools [11], [12], [13].
The presence of multidisciplinary teams in ICUs is not mandatory in most countries and in Brazil, few studies have been conducted on the effectiveness of NST care to critically ill patients, especially in Latin American countries [8], [14]. To fulfill this gap, the objective of the present study was to evaluate the effectiveness of NST activities related to ENT administration in ICUs.
Section snippets
Methods
This is a cross-sectional and analytic study that was approved by the research ethics committee of the Health Sciences Teaching and Research Foundation of the Brazilian Federal District (FEPECS/SES-DF, n˚ 943.1322015).
Results
Of the 17 hospitals members of the public health system, nine hospitals met the inclusion criteria and participated in the research. The audits were made between March and April of 2014 after all enrolled hospitals agreed fully to participate in the audit. In the initial group, 11 hospitals were excluded because they had <200 active hospital beds. Only three of nine hospitals that were included in the audit reached 75% of the agreement with NST activities (Questionnaire 1) and only 1 ICU scored
Discussion
The data presented here are important because they show that the activities performed by NST (Questionnaire 1) can promote a direct and positive impact on the quality of ENT administration in ICU settings (Questionnaire 2) with regard to the quality of local services. We can also hypothesize the presence of a causal relationship between these activities due to the association between the scores in both questionnaires. In addition, we also found a strong linear relationship between the use of
Conclusions
This study revealed that a well-implemented NST may improve ENT administration in ICU settings by complying with quality parameters. Adherence to protocols, continuing education of professionals and assessment of quality indicators also were found to be NST activities that should be prioritized and further studied. These specific activities could positively influence the adequacy of ENT administration and the achievement of nutritional goals. A study with a larger number of hospitals may
Acknowledgments
The authors thank all NST members at each hospital that participated in this research, particularly the nursing teams who kindly contributed to the data collection. The authors also thank Ana Beatrice De Oliveira for copyediting services.
References (24)
- et al.
Cost savings of an adult hospital nutrition support team
Nutrition
(2005) - et al.
Protected time for nutrition support teams: What are the benefits
Clin Nutr ESPEN
(2016) - et al.
Education program on medical nutrition and length of stay of critically ill patients
Clin Nutr
(2013) - et al.
Early enteral nutrition in critically ill patients: ESICM clinical practice guidelines
Intensive Care Med
(2017) - et al.
ASPEN safe practices for enteral nutrition therapy [Formula: See text]
JPEN J Parenter Enteral Nutr
(2017) - et al.
Costs of patients under nutritional therapy: From prescription to discharge
Curr Opin Clin Nutr Metab Care
(2004) - et al.
Strategies for high-quality nutrition therapy in Brazil
JPEN J Parenter Enteral Nutr
(2016) Regulamento Técnico sobre os requisitos mínimos exigidos para a Terapia de Nutrição Enteral. Ministério da Saúde
Agência Nacional de Vigilância Sanitária
(2000)- et al.
State of nutrition support teams
Nutr Clin Pract
(2013) - et al.
The action of a multidisciplinary team in the nutritional care of critically ill patients
Rev Nutr Campinas
(2005)
Nutrition support in intensive care units in England: A snapshot of present practice
Br J Nutr
The quality of care. How can it be assessed
JAMA
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Conflicts of interest: The authors of this study have no conflicts of interest to declare.
The authors did not receive funding for this research.