Honours research

I completed my fast tracked 6-month honours degree in the last year of my Bachelor of Nutrition and Dietetics. This was my first exposure to research and I had a fantastic experience whereby I recieved a GPA 7 for my project. I am extremely thankful for this, as it supported my application for my PhD, which was an academically competitive process. Unfortunately, I did publish this work as it was a quality improvement monitoring piece based at two healthcare sites on the Gold Coast. However, you can read the title and abstract of this work below.

Title

Optimal nutrition intake in the Intensive Care Unit: evaluation of Clinical Practice Guideline adherence 

Abstract

Introduction: The use of clinical practice guidelines to guide nutrition care of critically ill patients has been shown to improve clinical practice and result in improved adequacy of delivered artificial nutrition support to critically ill patients. Tailoring evidence-based clinical practice guidelines for nutrition is important for the implementation of recommendations relevant to the local context. The primary aim of this study was to measure clinician adherence to new, revised, and existing recommendations within a recently updated enteral nutrition feeding guideline for critically ill patients. The secondary aim of this study was to determine the nutritional adequacy of patients in the Intensive Care Unit (ICU) for whom the guideline was used. Method: A six-week retrospective observational chart audit of patients admitted to the ICUs at Gold Coast Health was undertaken. Nutrition specific data, including guideline adherence and nutritional adequacy, were collected for patients who received (or should have received) artificial nutrition support during their ICU stay. Data were collected for up to 12 days in the ICU, or until death or discharge, which ever came first. An a priori level of 80% adherence was set prior to data collection as a level of acceptable adherence. Following international reporting conventions, nutritional adequacy for prescribed energy and protein was also set at 80%. Results: Data were available for 76 patients who either received or should have received artificial nutrition support during their ICU stay within the audit timeframe. Guideline adherence was 80% for six of the 23 recommendations assessed. Adherence was observed more frequently for established recommendations; none of the new or updated recommendations met the pre-determined level of 80%. Just over half of patients who received or should have received nutrition support had a dietitian consultation. When enteral nutrition was administered it was commenced within the recommended timeframe of 12 hours in 43.1% of patients. Overall patients received an average 74.6% of prescribed calories and 64.7% of prescribed protein. For the total number of days nutrition support should have been provided (n=440 patient days), nutritional adequacy for prescribed energy and protein failed to reach >80% on 51.3% and 63.1% of patient days respectively. Nutritional adequacy for energy and protein compared to patients calculated body weight requirements failed to reach >80% on 65.9% and 73.2% of patient days respectively. The main reason for enteral feeds not starting at the target rate was ‘doctors orders’ and the main reason for enteral feed interruptions was ‘fasting for extubation’. Conclusion: Evaluation of the implementation of these new guidelines shows that there is a need for strategies to further embed recommendations, particularly those which have changed or are new. To improve guideline adherence, we recommend introducing suitable multifaceted implementation strategies to promote use of the guideline as this has been effective in improving guideline adherence and subsequently nutritional adequacy among patients in previous studies.

Thanks for reading.

Dr Nathan Cook (PhD, APD, AccSD)