Nutrition

Home
Audit
Guidelines
Protocols
Projects

Audit Section

Audit is an essential way of improving services: the cycle is as follows: examine current practice, compare with the 'Gold Standard', implement change, and re-examine practice to see if it has improved.

In nutritional terms, what is the 'Gold Standard'? As shown above there are a number of things that we can audit to check that we are fulfilling the basic recommendations that are currently available in critical care nutrition:
Do we use any form of nutritional assessment?
Are we feeding our patients early?
Are they receiving their calorific requirements as determined by the unit dietitian? If not why not?
Does our unit protocol allow for gastric residuals of up to 250mls or are feeds being stopped or reduced unnecessarily?
Are our patients being nursed at least 30 degrees head up? Do we use prokinetics appropriately?
Do we have safe naso-gastric tube practice in terms of checking that the tubes are in the correct place before use?
Are we using parenteral nutrition appropriately?

If the answer to some of these questions is no, it may be that the unit needs an update of its nutritional protocols to ensure that nutritional delivery is optimised

Nutritional audit tools for ICU (ICU Audit) and HDU (HDU Audit) are attached. The former looks in detail at adequacy of calorific delivery; the latter has a broader scope and is intended for units with a less well-developed nutritional service, to identify rectifiable deficiencies.

Nutrition Quality Improvement Survey

An international survey set up by the Canadian Critical Care Nutrition group, this survey is entering its second year and is to take place again in May 2008. Seven Scottish units took part in 2007 and the results compared very favourably to the other 151 units from around the world. The survey is an audit of nutrition for twenty consecutive patients in each ICU and compares the unit's practice to the recommendations of the Canadian Clinical Practice Guidelines. Material is available to help units build on the results and educate their staff about how to improve nutritional practice. Results are entered on line and each unit is sent a site report with comparisons against the other (anonymous) participating units. The units that took part last year found it to be a useful exercise which has stimulated some change. The information collected is very similar to that on the ICU Feeding Audit above. (see Scot QI Report)

Audit tools

ICU audit
HDU audit

Links from this page

Scot QI Report)

Home | Links | Sitemap | feedback | Contact us