"improving intensive care in Scotland"

Nutrition audit tools

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 seen on the previous page 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.

Example audit tools

Adequacy of calorific delivery...

ICU audit - click here

HDU audit - click here

Nutrition & complications...

HDU audit - click here

 

Examples of nutrition audits

1. Inter-rater Reliability of the Fife Intensive Care Unit Nutritional Screening Tool

click here

2. Weighing Patients in Scottish Critical Care Units: Weighed down by Inaccuracy?

click here

3. Re-feeding syndrome in intensive care. An audit of current nutrition screening and treatment

click here