The impact of ongoing audit on nutritional support in paediatric intensive care

[摘要] ENGLISH ABSTRACT:Objective: To assess the impact of a continuous auditing process on nutritionalsupport in a tertiary paediatric intensive care unit.Design: Prospective, longitudinal audit initiated in 1994. Re-auditing took placealmost every 2 years: 1994-1995, 1997-1998 and 2001, leading to completion of theaudit cycle.Setting: An 8 bed Paediatric Intensive Care Unit (PICU) in StMary's HospitalLondon.Subjects: All ventilated patients admitted for more than a complete 24-hour periodwere included in the audit. The units' standard daily fluid charts were used for datacollection. Data was collected until discharge from PICU or a maximum of 10 days.Incomplete and imprecise data was disregarded during the data analysis process.Outcome measures and interventions: The outcome measures include time taken toinitiate nutritional support, the route of feeding and delivery of calories by day 3,judged by the Estimated Average Requirements (EAR) for energy. Feedingalgorithms and protocols introduced after each audit: nasogastric feeding algorithmfollowing the 1994-1995 audit, blind nasojejunal tube insertion technique and relatedfeeding algorithms after the audit in 1997-1998.Results: Time taken to initiate enteral feeding was reduced from 15 hours (1994-1995) to 5.5 hours (2001). The proportion of parenterally fed patients fell from 11%(1994-1995) to 1% (200 1 ). The proportion of enterally fed patients via the nasojejunalroute rose from 1% (1994-1995) to 20% (2001). An increase was noticed in patientsreaching 50% and 70% of energy requirement by day 3 following admission wasdocumented: 7% in1994-1995 to 35% in 2001 for 70% of EAR (p = 0.0008) and 18% in 1994-1995 to 58% in 2001 for 50% ofEAR. (p< 0.0001)Conclusion: This audit process demonstrates the effectiveness of continuous auditingin an intensive care unit in improving the quality of nutritional support. This ispossible only with a multi-disciplinary team approach.

[发布机构] Stellenbosch University