Skip to main content
SpringerLink
Log in
Book cover

Diet and Nutrition in Critical Care pp 417–428Cite as

Top Ten Quality Indicators for Nutritional Therapy

  • Reference work entry
  • First Online:

  • 347 Accesses

Abstract

The identification of useful quality indicators for nutritional therapy (QINTs) is important but extremely challenging. The top ten most evidence-based and clinically relevant QINTs as chosen by experts on nutritional therapy are described in this chapter. Evidence from the available literature, psychometric techniques, and statistical tools was used to choose these QINTs. Limiting the number of QINTs to the ten most relevant should increase the routine use of these quality indicators in clinical practice. The top ten QINTs, in descending order, are:

  • Frequency of nutrition screening of hospitalized patients

  • Frequency of diarrhea

  • Frequency of involuntary removal of enteral feeding tubes

  • Frequency of feeding tube obstruction

  • Frequency of fasting more than 24 h

  • Frequency of glycemic dysfunction

  • Frequency of estimation of energy expenditure and protein needs

  • Incidence of central venous catheter infection

  • Compliance with indications for nutritional therapy

  • Frequency of use of subjective global assessment

To best use the QINT, it is important to clearly define each QINT, establish protocols for their use, and train all the staff involved in their application.

This is a preview of subscription content, log in via an institution.

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   999.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD   1,299.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

Abbreviations

ASPEN:

American Society for Parenteral and Enteral Nutrition

BMI:

Body mass index

CVC:

Central venous catheter

DITEN:

Brazilian Guidelines for Nutrition Therapy

EN:

Enteral nutrition

ENT:

Enteral nutrition therapy

ESPEN:

European Society for Clinical Nutrition and Metabolism

IBRANUTRI:

Brazilian National Survey of Nutrition

ICU:

Intensive care unit

IC:

Indirect calorimetry

ILSI:

International Life Sciences Institute

MUST:

Malnutrition Universal Screening Tool

NRS 2002:

Nutritional risk screening 2002

NST:

Nutrition support team

NT:

Nutritional therapy

PICC:

Peripherally inserted central catheter

PN:

Parenteral nutrition

PNT:

Parenteral nutrition therapy

PVC:

Peripheral venous catheter

QINT:

Quality indicators for nutritional therapy

REE:

Resting energy expenditure

SGA:

Subjective global assessment

References

  • ASPEN Board of Directors and Clinical Guidelines Task Force. Guidelines for the use of parenteral and enteral nutrition in adult and pediatric patients [published correction appears in J Parenter Enter Nutr. 2002;26:114]. J Parenter Enter Nutr. 2002;26:1SA–138.

    Google Scholar 

  • Barker LA, Gout BS, Crowe TC. Hospital malnutrition: prevalence, identification and impact on patients and the healthcare system. Int J Environ Res Public Health. 2011;8:514–27.

    Article  PubMed  PubMed Central  Google Scholar 

  • Berger MM, Chioléro RL. Hypocaloric feeding: pros and cons. Curr Opin Crit Care. 2007;13:180–6.

    Article  PubMed  Google Scholar 

  • Bittencourt AF, Martins JR, Logulo L, et al. Constipation is more frequent than diarrhea in patients fed exclusively by enteral nutrition: results of an observational study. Nutr Clin Pract. 2012;27:533–9.

    Article  PubMed  Google Scholar 

  • Borges SL, Pinheiro BV, Pace FHL, Chebli JMF. Diarreia Nosocomial em unidade de terapia intensiva: incidência e fatores de risco. Arq Gastroenterol. 2008;45:117–23.

    Article  PubMed  Google Scholar 

  • Campbell SM, Braspenning J, Hutchinson A, Marshall MN. Research methods used in developing and applying quality indicators in primary care. BMJ. 2003;326:816–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Devos P, Preiser JC. Current controversies around tight glucose control in critically ill patients. Curr Opin Clin Nutr Metab Care. 2007;10:206–9. Review.

    Article  PubMed  Google Scholar 

  • Doig GS, Heighes PT, Simpson F, et al. Early enteral nutrition, provided within 24 h of injury or intensive care unit admission, significantly reduces mortality in critically ill patients: a meta-analysis of randomised controlled trials. Intensive Care Med. 2009;35:2018–27.

    Article  CAS  PubMed  Google Scholar 

  • Dvir D, Cohen J, Singer P. Computerized energy balance and complications in critically ill patients: an observational study. Clin Nutr. 2006;25:37–44.

    Article  PubMed  Google Scholar 

  • Elia M, Zellipour L, Stratton RJ. To screen or not to screen malnutrition? Clin Nutr. 2005;24:867–84.

    Article  CAS  PubMed  Google Scholar 

  • Fahy BG, Sheehy AM, Coursin DB. Glucose control in the intensive care unit. Crit Care Med. 2009;37:1769–76.

    Article  CAS  PubMed  Google Scholar 

  • Ferrie S, East V. Managing diarrhoea in intensive care. Aust Crit Care. 2007;20:7–13.

    Article  PubMed  Google Scholar 

  • Gacouin A, Camus C, Gros A, Isslame S, Marque S, Lavoué S, Chimot L, Donnio PY, Le Tulzo Y. Constipation in long-term ventilated patients: associated factors and impact on intensive care unit outcomes. Crit Care Med. 2010;38:1933–8.

    Article  PubMed  Google Scholar 

  • García-Rodicio S, Abajo C, Godoy M, Catalá MA. Development and implementation of an audit tool for quality control of parenteral nutrition. Nutr Clin Pract. 2009;24:500–7.

    Article  PubMed  Google Scholar 

  • Garey KW, Graham G, Gerard L, Dao T, Jiang ZD, Price M, Dupont HL. Prevalence of diarrhea at a university hospital and association with modifiable risk factors. Ann Pharmacother. 2006;40:1030–4.

    Article  PubMed  Google Scholar 

  • Gramlich L, Kichian K, Pinilla J, Rodych NJ, Dhaliwal R, Heyland DK. Does enteral nutrition compared to parenteral nutrition result in better outcomes in critically ill adult patients? A systematic review of the literature. Nutrition. 2004;20:843–8.

    Article  PubMed  Google Scholar 

  • Grau T, Bonet A. Caloric intake and liver dysfunction in critically ill patients. Curr Opin Clin Nutr Metab Care. 2009;12:175–9.

    Article  PubMed  Google Scholar 

  • Hanlon P, Byersm M, Walker BR, Summerton C. Chapter 5, Environmental and nutritional factors in disease. In: Boon NA, Colledge NR, Walker BR, Hunter JAA, editors. Davidson’s principles and practice of medicine. 20th ed. London: Elsevier; 2006.

    Google Scholar 

  • Heyland DK, Cahill NE, Dhaliwal R, Sun X, Day AG, McClave SA. Impact of enteral feeding protocols on enteral nutrition delivery: results of a multicenter observational study. J Parenter Enter Nutr. 2010;34:675–84.

    Article  Google Scholar 

  • Howard P, Jonkers-Schuitema C, Furniss L, Kyle U, Muehlebach S, Odlund-Olin A, Page M, Wheatley C. Managing the patient journey through enteral nutritional care. Clin Nutr. 2006;25:187–95.

    Article  CAS  PubMed  Google Scholar 

  • Jack L, Coyer F, Courtney M, Venkatesh B. Diarrhea risk factors in enterally tube fed critically ill patients: a retrospective audit. Intensive Crit Care Nurs. 2010;26:327–34.

    Article  PubMed  Google Scholar 

  • Jensen GL, Mirtallo J, Compher C, International Consensus Guideline Committee, et al. Adult starvation and disease-related malnutrition: a proposal for etiology-based diagnosis in the clinical practice setting from the International Consensus Guideline Committee. J Parenter Enter Nutr. 2010;34:156–9.

    Article  Google Scholar 

  • Kreymann KG. Early nutrition support in critical care: a European perspective. Curr Opin Clin Nutr Metab Care. 2008;11:156–9.

    Article  PubMed  Google Scholar 

  • Kyle UG, Pirlich M, Lochs H, Schuetz T, Pichard C. Increased length of hospital stay in underweight and overweight patients at hospital admission: a controlled population study. Clin Nutr. 2005;24:133–42.

    Article  PubMed  Google Scholar 

  • Lacherade JC, Jabre P, Bastuji-Garin S, Grimaldi D, Fangio P, Théron V, et al. Failure to achieve glycemic control despite intensive insulin therapy in a medical ICU: incidence and influence on ICU mortality. Intensive Care Med. 2007;33:814–21.

    Article  CAS  PubMed  Google Scholar 

  • Lebeaux D, Zarrouk V, Leflon-Guibout V, Lefort A, Fantin B. Totally implanted access port-related infections: features and management. Rev Med Interne. 2010;31:819–27.

    Article  CAS  PubMed  Google Scholar 

  • Lochs H, Allison SP, Meier R, Pirlich M, Kondrup J, Schneider S, et al. Introductory to the ESPEN guidelines on enteral nutrition: terminology, definitions and general topics. Clin Nutr. 2006;25:180–6.

    Article  CAS  PubMed  Google Scholar 

  • Lord LM. Restoring and maintaining patency of enteral feeding tubes. Nutr Clin Pract. 2003;18:422–6.

    Article  PubMed  Google Scholar 

  • Luft VC, Beghetto MG, Mello ED, Polanczyk CA. Role of enteral nutrition in the incidence of diarrhea among hospitalized adult patients. Nutrition. 2008;24:528–35.

    Article  PubMed  Google Scholar 

  • Malone AM, Seres DS, Lord L. Complications of enteral nutrition. In: Gottschlich MM, editor. Nutrition Services Shriners Hospitals for Children, Cincinnati, OH. ASPEN; 2007. p. 246–63.

    Google Scholar 

  • Martí-Bonmatí E, Ortega-García MP, Cervera-Casino P, Lacasa C, Llop JL, Villalobos JL, de la Morena L. Estudiomulticéntrico de prevalencia de hiperglucamia en pacientes hospitalizados con nutrición parenteral. Farm Hosp. 2006;30:12–9.

    Article  PubMed  Google Scholar 

  • Martín FT, Alvarez HJ, Burgos PR, Celaya PS, Calvo HMV, García de Lorenzo A, Grupo de Trabajo de Gestión de SENPE, et al. Analysis of the relevance and feasibility of quality indicators in nutrition support. Nutr Hosp. 2012;27:198–204.

    Google Scholar 

  • Martins JR, Verotti CC, Shiroma GM, Waitzberg DL. Re: development and implementation of an audit tool for quality control of parenteral nutrition. Nutr Clin Pract. 2010;25:221–2.

    Article  PubMed  Google Scholar 

  • Martins JR, Shiroma GM, Horie LM, Logullo L, Silva MD, Waitzberg DL. Factors leading to discrepancies between prescription and intake of enteral nutrition therapy in hospitalized patients. Nutrition. 2012:28:864–7.

    Article  PubMed  Google Scholar 

  • McClave SA. Indirect calorimetry: relevance to patient outcome. Respir Care Clin N Am. 2006;12:635–50.

    PubMed  Google Scholar 

  • McClave SA, Sexton LK, Spain DA, Adams JL, Owens NA, Sullins MB, Blandford BS, Snider HL. Enteral tube feeding in the intensive care unit: factors impeding adequate delivery. Crit Care Med. 1999;27:1252–6.

    Article  CAS  PubMed  Google Scholar 

  • McClave SA, Martindale RG, Vanek VW, A.S.P.E.N. Board of Directors, American College of Critical Care Medicine, Society of Critical Care Medicine, et al. Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.). J Parenter Enter Nutr. 2009;33:277–316.

    Article  Google Scholar 

  • Mostafa SM, Bhandari S, Ritchie G, Gratton N, Wenstone R. Constipation and its implications in the critically ill patient. Br J Anaesth. 2003;91:815–9.

    Article  CAS  PubMed  Google Scholar 

  • Nassar Jr AP, da Silva FM, de Cleva R. Constipation in intensive care unit: incidence and risk factors. J Crit Care. 2009;24:630.

    Article  PubMed  Google Scholar 

  • O’Grady NP, Alexander M, Burns LA, Dellinger EP, Garland J, Heard SO, Healthcare Infection Control Practices Advisory Committee, et al. Guidelines for the prevention of intravascular catheter-related infections. Am J Infect Control. 2011;39 Suppl 1:S1–34.

    Article  PubMed  Google Scholar 

  • O’Leary-Kelley CM, Puntillo KA, Barr J, Stotts N, Douglas MK. Nutritional adequacy in patients receiving mechanical ventilation who are fed enterally. Am J Crit Care. 2005;14:222–31.

    PubMed  Google Scholar 

  • Pinilla JC, et al. Comparison of gastrointestinal tolerance to two enteral feeding protocols in critically III patients: a prospective, randomized controlled trial. J Parenter Enter Nutr. 2001;25:81–6.

    Article  CAS  Google Scholar 

  • Raslan M, Gonzalez MC, Dias MCG, Paes-Barbosa FC, Cecconello I, Waitzberg DL. Aplicabilidade dos métodos de triagem nutricional no paciente hospitalizado. Rev Nutr. 2008;21:553–61.

    Google Scholar 

  • Raslan M, Gonzalez MC, Torrinhas RS, Ravacci GR, Pereira JC, Waitzberg DL. Complementarity of Subjective Global Assessment (SGA) and Nutritional Risk Screening 2002 (NRS 2002) for predicting poor clinical outcomes in hospitalized patients. Clin Nutr. 2011;30:49–53.

    Article  PubMed  Google Scholar 

  • Rubenstein LZ, Harker JO, Salvà A, Guigoz Y, Vellas B. Screening for undernutrition in geriatric practice: developing the short-form mini- nutritional assessment (MNA-SF). J Gerontol A Biol Sci Med Sci. 2001;56:366–72.

    Article  Google Scholar 

  • Singer P, Cohen J. Clinical applications of indirect calorimetry in the intensive care setting. In: Vincent J.-L, editor. Yearbook of intensive care and emergency medicine. New York: Springer; 2007. p. 912–9.

    Google Scholar 

  • Singer P, Anbar R, Cohen J, Shapiro H, Shalita-Chesner M, Lev S, et al. The tight calorie control study (TICACOS): a prospective, randomized, controlled pilot study of nutritional support in critically ill patients. Intensive Care Med. 2011;37:601–9.

    Article  PubMed  Google Scholar 

  • Stotter AT. Junctional care: the key to prevention of catheter sepsis in intravenous feeding. J Parenter Enter Nutr. 1987;11:159–62.

    Article  CAS  Google Scholar 

  • Stratton RJ, Hackston A, Longmore D, et al. Malnutrition in hospital outpatients and in patients: prevalence, concurrent validity and ease of use of the ‘malnutrition universal screening tool’ (‘MUST’) for adults. Br J Nutr. 2004;92:799–808.

    Article  CAS  PubMed  Google Scholar 

  • Van den Berghe G, Bouillon R, Mesotten D. Glucose control in critically ill patients. N Engl J Med. 2009;361:89; author reply 91–2.

    Article  PubMed  Google Scholar 

  • Verotti CCG, Torrinhas RS, Cecconello I, Waitzberg DL. The top ten quality indicator for nutritional therapy. Nutr Clin Pract. 2012;27:261–7.

    Article  PubMed  Google Scholar 

  • Villet S, Chiolero RL, Bollmann MD, Revelly JP, Cayeux RNMC, Delarue J, et al. Negative impact of hypocaloric feeding and energy balance on clinical outcome in ICU patients. Clin Nutr. 2005;24:502–9.

    Article  PubMed  Google Scholar 

  • Vituri DW, Matsuda LM. Validação de conteúdo de indicadores de qualidade para avaliação do cuidado de enfermagem. Rev Esc Enferm USP. 2009;43:429–37.

    Article  PubMed  Google Scholar 

  • Waitzberg DL. Indicadores de qualidade em terapia nutricional. São Paulo: ILSI Brasil; 2008.

    Google Scholar 

  • Waitzberg DL. A difference must make a difference. J Parenter Enter Nutr. 2010;34:604–5.

    Article  Google Scholar 

  • Waitzberg DL, Correia MI. Nutritional assessment in the hospitalized patient. Curr Opin Clin Nutr Metab Care. 2003;6:531–8.

    Article  PubMed  Google Scholar 

  • Waitzberg DL, Caiaffa WT, Correia MI. Hospital malnutrition: the Brazilian national survey (IBRANUTRI): a study of 4000 patients. Nutrition. 2001;17:573–80.

    Article  CAS  PubMed  Google Scholar 

  • Webster NR, Galley HF. Nutrition in the critically ill patient. J R Coll Surg Edinb. 2000;45:373–9. Review.

    CAS  PubMed  Google Scholar 

  • Whelan K. Enteral-tube-feeding diarrhea: manipulating the colonic microbiota with probiotics and prebiotics. Proc Nutr Soc. 2007;66:299–306.

    Article  PubMed  Google Scholar 

  • Wong S, Derry F, Jamous A, Hirani SP, Grimble G, Forbes A. The prevalence of malnutrition in spinal cord injuries patients: a UK multicentre study. Br J Nutr. 2011;15:1–6.

    Google Scholar 

Download references

Author information

Author notes

  1. Cristiane Comeron Gimenez Verotti

    Present address: , Estrada da Serrinha 321 quadra 02 casa 13. Vila Santo Antônio, São Roque, SP, Brazil

Authors and Affiliations

  1. Departamento de Gastroenterologia da Faculdade de Medicina, Universidade de São Paulo, LIM 35 Av. Dr. Arnaldo 455, Cerqueira Cesar, São Paulo, SP, Brazil

    Cristiane Comeron Gimenez Verotti

  2. Residência de Nutrição Clínica, EMTN, Hospital de Base do DF, MHS Q 101, 7033000, Brasília, DF, Brazil

    Guilherme Duprat Ceniccola

  3. Royal Free London Hospitals, Barnet General Hospital, London, UK

    Rajkumar Rajendram

  4. Division of Diabetes and Nutritional Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, UK

    Rajkumar Rajendram

  5. King Khalid University Hospital, King Saud University Medical City, Riyadh, Saudi Arabia

    Rajkumar Rajendram

Authors
  1. Cristiane Comeron Gimenez Verotti
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Guilherme Duprat Ceniccola
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Rajkumar Rajendram
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Cristiane Comeron Gimenez Verotti .

Editor information

Editors and Affiliations

  1. Royal Free London Hospitals, Barnet General Hospital, London, UK

    Rajkumar Rajendram

  2. Division of Diabetes & Nutritional Sciences, Faculty of Life Sciences & Medicine, King’s College London, London, UK

    Rajkumar Rajendram

  3. King Khalid University Hospital, King Saud University Medical City, Riyadh, Saudi Arabia

    Rajkumar Rajendram

  4. Department of Nutrition and Dietetics, Division of Diabetes & Nutritional Sciences, Faculty of Life Sciences & Medicine, King’s College London, London, UK

    Victor R. Preedy

  5. Department of Biomedical Sciences, Faculty of Science & Technology, University of Westminster, London, UK

    Vinood B. Patel

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer Science+Business Media New York

About this entry

Cite this entry

Verotti, C.C., Ceniccola, G.D., Rajendram, R. (2015). Top Ten Quality Indicators for Nutritional Therapy. In: Rajendram, R., Preedy, V.R., Patel, V.B. (eds) Diet and Nutrition in Critical Care. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-7836-2_151

Download citation

  • DOI: https://doi.org/10.1007/978-1-4614-7836-2_151

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4614-7837-9

  • Online ISBN: 978-1-4614-7836-2

  • eBook Packages: MedicineReference Module Medicine

Publish with us

Policies and ethics

Search

Navigation