Improving the Practice of Nutrition Therapy in the Critically Ill: An International Quality Improvement Project

What is the Nutrition QI Project?

To date, there have been three international period prevalence surveys of nutrition therapies in Intensive Care Units (ICUs).  The most recent survey commenced on 16 September 2009.  This ongoing quality improvement (QI) initiative, aims to compare current nutrition practices in ICUs within and across different countries. The aim of the initiative is to illuminate differences, highlight strengths and weaknesses, and hopefully lead to practice improvements. 

Who can participate in the Nutrition QI Project? 

To be eligible, ICUs must have a minimum of 8 beds and have an individual(s) with adequate knowledge of clinical nutrition to be able to complete the data collection (e.g. registered dietitian, research co-ordinator, physician, pharmacist). In 2008, 157 ICUs participated from 18 countries. 

I work in an ICU with fewer than 8 beds, can I still participate?

As the main objective of the survey is quality improvement, we do have some flexibility regarding the numbers of beds and patients included. We encourage you to still participate, even if the ICU you work in has fewer than 8 beds, and we will still prepare a site report for you to see the strengths and weaknesses of your ICU as long as you collect and finalize data on a minimum of 8 patients. 

What does participation involve?

Participating ICUs collect and enter data on a minimum of 20 adult mechanically ventilated patients using a web-based data collection tool. The data collected includes hospital and ICU characteristics, patient characteristics, the elements of the APACHE II score, type of nutrition received, morning blood sugars, insulin, length of stay, mortality, etc. Some data is collected daily for a maximum of 12 days (from date of ICU admission onwards). The average time spent for data collection and entry is approximately 2 hours per patient.

Why should I participate?

There is no remuneration for participating in this project. Rather, ICUs are provided with a benchmarked performance report highlighting their strengths and weaknesses in comparison to other ICUs in the database and to the Canadian Clinical Practice Guidelines.
Participating in the project is also an opportunity to increase awareness of nutrition in ICU. Participants tell us that they gain personally from the experience of being involved in an international research endeavor that will be published in a peer-reviewed journal and presented internationally. For example, results from the 2008 survey were presented at the Asia Pacific Critical Care 2008 Conference to be held in Sydney, Australia in November 2008. The results of the 2009 survey will be presented at ASPEN’s Clinical Nutrition Week, to be held in Las Vegas, Nevada, February 8-12 2010. Please click here to see a program for the Critical Care portion of Clinical Nutrition week!    

How can I participate?

The International Nutrition Survey for 2009 will begin on September 16. Please keep checking the website for more information about this next opportunity to evaluate your practice.

 

What if I participated last year, and would like to participate again this year?

If you participated in the International Nutrition Survey previously, and your ethics approval is still valid, you may be able to renew your ethics approval for the next survey rather than submitting an entirely new ethics application. No changes have been made to the protocol or data collection procedures for the International Nutrition Survey between 2008 and 2009 with the following exceptions:
This year we are asking whether or not probiotic/prebiotic/synbiotic supplementation was given; last year no such question was present in the survey. We are asking which (if any) parenteral solutions were given; this replaces the question on last year’s survey referring to the lipid composition of parenteral solutions. You will also be asked to record all enteral nutrition feeding interruptions, and the reason(s) for these interruptions; last year, only interruptions due to intolerance were indicated.

I work in a Pediatric ICU, can I still participate?

Yes, in 2009 we are very excited to announce that in addition to the international audit in adult critically ill patients we are collaborating with the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) to conduct a parallel initiative focused on pediatric patients.  The 2009 pediatric survey also started on 16th September 2009 and involved the same data collection procedures as the adult survey. The Pediatric site can be found here, and please contact Lori Bechard ( This e-mail address is being protected from spam bots, you need JavaScript enabled to view it ) for more information.  

Are there any other opportunities to get involved in research on Critical Care Nutrition?

Yes, we will also be looking for participants in a variety of research projects that will be designed to illuminate the barriers to providing adequate nutrition as well as to implement strategies that will improve the quantity of nutrition provided.  We would like to invite you to consider partnering with us to improve the amount of nutrition you provide to your ICU patients by participating with us in this exciting research program.  If this is of interest to you, please email Naomi Cahill at This e-mail address is being protected from spam bots, you need JavaScript enabled to view it .