Bedside Tools                                  

NUTRIC Score

Creator: Critical Care Nutrition
Date: March 19, 2013
Synopsis: This one-page information sheet outlines how to score and calculate the NUTRIC Score. The NUTRIC Score is designed to quantify the risk of critically ill patients developing adverse events that may be modified by aggressive nutrition therapy. The NUTRIC Score is built into the Bedside Nutrition Monitoring Tool, which you can access here.

PEP uP Excel Daily Checklist

Creator: Naomi Cahill and Lauren Murch
Date: December 2010
Synopsis: An excel spreadsheet used to monitor the progress of enteral nutrition.  Automatically generates a graphical visual of the adequacy of nutrition delivered.

Adjusting Goal Feed Rates for Propofol

Creator: Jan Greenwood
Date: Summer 2010
Synopsis: This Bedside Tool outlines how and when to adjust feed rates to account for propofol in order to avoid overfeeding.

Nutrichu and Nutrichu User Guide

Creator: Jean-Charles Preiser
Date: Spring 2011
Synopsis: The purpose of the "NutriChu" software is to improve the nutritional therapy by adapting the prescription to the actual status of critically ill patients staying in intensive care units. "NutriChu" enables the calculation of the actual caloric and protein intakes, and the comparison with recommended targets (goals). The results are calculated automatically and displayed graphically. This software is the result of a close multi-disciplinary collaboration of different departments at the University Hospital of Liege (Belgium), and involved physicians; nurses, dieticians, pharmacists cooperating with Nutritional Team of the hospital.

Care and Management of Nasoduodenal Feeding Tubes

Creator: Jan Greenwood
Date: 01/04/2010
Synopsis: This Bedside Tool includes information on securing nasoduodenal tubes, initiating and titrating feeds, prevention of aspiration, and other troublshooting tips related to post-pyloric feeding.

Daily EN Checklist

Synopsis: This checklist for monitoring of EN helps determine if EN goals (to safely deliver >80% of calories daily) are being met, and if not, if appropriate startegies are being adopted (motility agents, small bowel feeds, etc) to achieve the highest possible EN adequacy.

EN Guideline for Surgical Procedures

Creator: Developed by: Dr Michael Meier, Adapted by: Dr John Drover
Date: Summer 2010
Synopsis: This guideline is meant to assist with the management of enteral feeding in critically ill patients that are going the operating room for a procedure. It outlines when to stop feeds prior to transfer to the operating room, and when/how to restart feeds upon the patient's return to the ICU.

Gastric Feeding Algorithm

Creator: Jan Greenwood
Date: 01/04/2010
Synopsis: This Bedside Tool is a visual step-by-step guide to gastric feeding and managing high gastric residual volumes in the critically ill, where the goal is to safely deliver >80% of calories daily.

Glycemic Control Protocol

Creator: KGH
Synopsis: This glycemic control protocol outlines frequency of monitoring blood glucose under various conditions, dosing and infusion rates for initiation of insulin therapy (when blood glucose is >9mmol/L) and dosing and infusion rates for continuation of insulin therapy.

Head of Bed Elevation Sticker

Date: 2009
Synopsis: These stickers are intended to be printed and placed on the patients feeding bag as a reminder to bed-side staff to elevate the head of the bed. The Head of Bed word or pdf files can be printed directly onto Avery 3-1/3"" x 4"" labels (compatible product codes are 5164, 5264, 5524, 8164, 8254, 8464, 48464, 55164, 58164, 48264).

ICU Guideline: Managing the Refeeding Syndrome

Creator: Jan Greenwood
Date: 01/04/2010
Synopsis: This Bedside Tool defines refeeding syndrome and provides information on monitoring patients at risk for refeeding syndrome, and adjusting the initiation and titration of feeds in those patients.

Management of Diarrhea Algorithm

Creator: Jan Greenwood
Date: 01/04/2010
Synopsis: This algorithm is a visual step-by-step guide to management of diarrhea in the critically ill.

Nasal/Oral Duodenal Feeding Tube Placement

Creator: Jan Greenwood
Date: Summer 2010
Synopsis: This pocket guide gives step by step information on placing post-pyloric feeding tubes. Also includes information on indications/contraindications, supplies needed and problem solving tips.

Nutrition Assessment checklist

Creator: Jan Greenwood
Date: Summer 2010
Synopsis: The Nutrition Assessment Checklist is a Bedside Tool designed to help dietitians identify patients who are at nutritional risk, to determine and record a nutrition care plan, and to make progress notes.

Parenteral Nutrition Algorithm

Creator: Jan Greenwood
Date: 01/04/2010
Synopsis: This algorithm is a visual step-by-step guide to use of PN in the critically ill.

PN Preprinted Orders

Creator: KGH
Synopsis: This is a pre-printed order for provision of parenteral nutrition. It also includes guidelines for calculation of energy requirements.

QI Assessment Form

Creator: Jan Greenwood
Date: 01/04/2010
Synopsis: This bedside quality improvement tool is used to track nutrition prescribed, calories and protein received, as well as interruptions to delivery of enteral nutrition. Use one form per patient, with rows in the form representing days in ICU.

PEP uP Diarrhea Guideline

Creator: PEP uP Study Team
Date: December 2010
Synopsis: This reference sheet provides a guideline for potential causes of diarrhea and factors to consider in its management.. It was developed for use alongside the PEP uP Protocol.

Post-Pyloric Feeding Algorithm

Creator: Jan Greenwood
Date: Summer 2010
Synopsis: This Bedside Tool is a visual step-by-step guide to post-pyloric feeding in the critically ill. Includes information on initiation and advancement of post-pyloric feeds, and when post-pyloric feeding is and is not appropriate.

Rapid Resource 1: Feeding Facts

Creator: Jan Greenwood
Date: Summer 2010
Synopsis: This pocket guide provides quick information on initiation, maintenance and termination of enteral nutrition.

Rapid Resource 2: TPN

Creator: Jan Greenwood
Date: 01/04/2010
Synopsis: This pocket guide gives information on determining energy requirements, calculating PN prescription, identifying and managing GI and metabolic complications.

                           Information Documents                           

Feeding Your Family Member in the ICU

Date: 08/02/2011
Synopsis: This document is targeted at patients’ family members, and contains information about why nutrition therapy might be required, and types of nutrition therapy that may be provided. It suggests things family members can do to help with feeding their loved one, such as questions they should be prepared to answer (such as patient’s height and usual weight, nutritional status) as well as some questions they should ask about their family member’s nutrition in the ICU.

Routes of Nutrition Support Algorithm

Creator: Jan Greenwood
Date: 01/04/2010
Synopsis: This algorithm is a visual step-by-step guide to deciding what route of nutrition a patient should receive.

Clinical Practice Guidelines Brochure

Date: 2009
Synopsis: This 4-page brochure developed in collaboration with Nestle Canada highlights key clinical practice guideline recommendations.

NIBBLE Issue 1: Nutritional Adequacy

Date: 01/07/2010
Synopsis: This one-page "Nutrition Information Byte" (NIBBLE) is designed to educate individuals on hot topics in nutrition. Issue 1 deals with The Importance of Nutritional Adequacy (Or Avoiding Caloric Debt). You can download the NIBBLE in pdf and doc formats. There is also a version specifically for International Nutrition Survey participants, which allows you to enter some more specific information about your site, from your Site Report. We encourage you to distribute these NIBBLES in your ICU to increase awareness about these important nutrition topics!

Generic version:  Custom version:

NIBBLE Issue 2: Strategies to Deal with GI Intolerance

Date: 20/01/2011
Synopsis: This one-page "Nutrition Information Byte" (NIBBLE) is designed to educate individuals on hot topics in nutrition. Issue 2 deals with Strategies to Deal with GI Intolerance. You can download the NIBBLE in pdf and doc formats. There is also a version specifically for International Nutrition Survey participants, which allows you to enter some more specific information about your site, from your Site Report. We encourage you to distribute these NIBBLES in your ICU to increase awareness about these important nutrition topics!

Generic version:  Custom version:

NIBBLE Issue 3: Should We Enteral Feed Patients Who Are Hemodynamically Unstable?

Date: 20/01/2011
This one-page "Nutrition Information Byte" (NIBBLE) is designed to educate individuals on hot topics in nutrition. Issue 3 deals with the question of enteral feeding patients who are hemodynamically unstable. You can download the NIBBLE in pdf and doc formats. We encourage you to distribute these NIBBLES in your ICU to increase awareness about these important nutrition topics!

NIBBLE Issue 4

Creator: PEPuP Study Team
Date: January 26, 2011
Synopsis: This one-page "Nutrition Information Byte" (NIBBLE) is designed to educate individuals on hot topics in nutrition. Issue 4 deals with the question of enteral feeding and the critically ill patient with intestinal surgery. You can download the NIBBLE in pdf and doc formats. We encourage you to distribute these NIBBLES in your ICU to increase awareness about these important nutrition topics!

NIBBLE Issue 5: The North American vs. European controversy continues: The timing of supplemental parenteral nutrition in the critically ill

Date: 21/10/2011
This one-page "Nutrition Information Byte" (NIBBLE) is designed to educate individuals on hot topics in nutrition. Issue 5 deals with the timing of supplemental parenteral nutrition in the critically ill. You can download the NIBBLE in pdf and doc formats. We encourage you to distribute these NIBBLES in your ICU to increase awareness about these important nutrition topics!

NIBBLE Issue 7: Trophic Feeds for Patients with Acute Lung Injury? No! Read On...

Date: 28/02/2012
This one-page "Nutrition Information Byte" (NIBBLE) is designed to educate individuals on hot topics in nutrition. Issue 7 discusses trophic feeds in the critically ill, offers some interpretation of the recent ARDSNET study published in JAMA, and presents some strategies for dealing with some of these patients. You can download the NIBBLE in pdf and doc formats. We encourage you to distribute these NIBBLES in your ICU to increase awareness about these important nutrition topics!

NIBBLE Issue 9: Measuring GRVs

Date: 21/03/2013
Synopsis: This one-page "Nutrition Information Byte" (NIBBLE) is designed to educate individuals on hot topics in nutrition. Issue 9 deals with the ongoing debate around measuring gastric residual volumes and addresses recent research on the topic. You can download the NIBBLE in pdf and doc formats. We encourage you to distribute these NIBBLES in your ICU to increase awareness about these important nutrition topics!

NIBBLE Issue 10: The Role of Glutamine Supplementation in Critical illness Given the Results of the REDOXS Study

Date: 10/04/2013
Synopsis: This one-page "Nutrition Information Byte" (NIBBLE) is designed to educate individuals on hot topics in nutrition. Issue 10 is a 2-page concise summary of the impact of REDOXS on the future use of glutamine in critically ill patients.

Generic version:

Rapid Resource 3: Tube Tips

Creator: Jan Greenwood
Date: Summer 2010
Synopsis: This pocket guide provides quick information on choosing a feeding route, placement method and type of tube. Also includes information on securing tubes and clearing occluded tubes.

Sample Press Release

Synopsis: This is a press release from Kingston General Hospital from participation in the 2008 International Nutrition Survey.

Template for Press Release

Date: 01/03/2010
Synopsis: This is a template of a press release designed to help you communicate the results of your participation in the most recent International Nutrition Survey.

                                     Multimedia                                     

SCCM Pharmaconutrition Podcast

Date: 2009
Synopsis: This is a podcast on the topic pharmaconutrition by Dr Daren Heyland. It is presented by the Society of Critical Care Medicine (SSCM).

Critical Care Nutrition course from Dietitians of Canada

                           Summaries of Evidence                           

Summary of Evidence: EN vs PN

Date: 2013
Synopsis: These are Summaries of Evidence from our Canadian Critical Care Nutrition Clinical Practice Guidelines. Click here for a full list of topics.

Summary of Evidence: Early vs Delayed EN

Date: 2013
Synopsis: These are Summaries of Evidence from our Canadian Critical Care Nutrition Clinical Practice Guidelines. Click here for a full list of topics.

Summary of Evidence: Use of Indirect Calorimetry vs Predictive Equation

Date: 2013
Synopsis: These are Summaries of Evidence from our Canadian Critical Care Nutrition Clinical Practice Guidelines. Click here for a full list of topics.

Summary of Evidence: Achieving target dose of EN

Date: 2013
Synopsis: These are Summaries of Evidence from our Canadian Critical Care Nutrition Clinical Practice Guidelines. Click here for a full list of topics.

Summary of Evidence: Intentional underfeeding: trophic vs full feeds

Date: 2013
Synopsis: These are Summaries of Evidence from our Canadian Critical Care Nutrition Clinical Practice Guidelines. Click here for a full list of topics.

Summary of Evidence: Intentional Underfeeding: Hypocaloric EN

Date: 2013
Synopsis: These are Summaries of Evidence from our Canadian Critical Care Nutrition Clinical Practice Guidelines. Click here for a full list of topics.

Summary of Evidence: Arginine

Date: 2013
Synopsis: These are Summaries of Evidence from our Canadian Critical Care Nutrition Clinical Practice Guidelines. Click here for a full list of topics.

Summary of Evidence: Fish oils, Borage Oils and Antioxidants

Date: 2013
Synopsis: These are Summaries of Evidence from our Canadian Critical Care Nutrition Clinical Practice Guidelines. Click here for a full list of topics.

Summary of Evidence: Fish oils Supplementation

Date: 2013
Synopsis: These are Summaries of Evidence from our Canadian Critical Care Nutrition Clinical Practice Guidelines. Click here for a full list of topics.

Summary of Evidence: Glutamine

Date: 2013
Synopsis: These are Summaries of Evidence from our Canadian Critical Care Nutrition Clinical Practice Guidelines. Click here for a full list of topics.

Summary of Evidence: Ornithine Ketoglutarate (OKG)

Date: 2013
Synopsis: These are Summaries of Evidence from our Canadian Critical Care Nutrition Clinical Practice Guidelines. Click here for a full list of topics.

Summary of Evidence: Protein/Peptides

Date: 2013
Synopsis: These are Summaries of Evidence from our Canadian Critical Care Nutrition Clinical Practice Guidelines. Click here for a full list of topics.

Summary of Evidence: pH

Date: 2013
Synopsis: These are Summaries of Evidence from our Canadian Critical Care Nutrition Clinical Practice Guidelines. Click here for a full list of topics.

Summary of Evidence: Fibre

Date: 2013
Synopsis: These are Summaries of Evidence from our Canadian Critical Care Nutrition Clinical Practice Guidelines. Click here for a full list of topics.

Summary of Evidence: Feeding Protocols

Date: 2013
Synopsis: These are Summaries of Evidence from our Canadian Critical Care Nutrition Clinical Practice Guidelines. Click here for a full list of topics.

Summary of Evidence: Motility Agents

Date: 2013
Synopsis: These are Summaries of Evidence from our Canadian Critical Care Nutrition Clinical Practice Guidelines. Click here for a full list of topics.

Summary of Evidence: Small Bowel Feeding

Date: 2013
Synopsis: These are Summaries of Evidence from our Canadian Critical Care Nutrition Clinical Practice Guidelines. Click here for a full list of topics.

Summary of Evidence: Body Position

Date: 2013
Synopsis: These are Summaries of Evidence from our Canadian Critical Care Nutrition Clinical Practice Guidelines. Click here for a full list of topics.

Summary of Evidence: Threshold of Gastric Residual Volumes

Date: 2013
Synopsis: These are Summaries of Evidence from our Canadian Critical Care Nutrition Clinical Practice Guidelines. Click here for a full list of topics.

Summary of Evidence: Discarding Gastric Residual Volumes

Date: 2013
Synopsis: These are Summaries of Evidence from our Canadian Critical Care Nutrition Clinical Practice Guidelines. Click here for a full list of topics.

Summary of Evidence: Closed vs Open System

Date: 2013
Synopsis: These are Summaries of Evidence from our Canadian Critical Care Nutrition Clinical Practice Guidelines. Click here for a full list of topics.

Summary of Evidence: Prebiotics

Date: 2013
Synopsis: These are Summaries of Evidence from our Canadian Critical Care Nutrition Clinical Practice Guidelines. Click here for a full list of topics.

Summary of Evidence: Continuous vs Other Methods of Administration

Date: 2013
Synopsis: These are Summaries of Evidence from our Canadian Critical Care Nutrition Clinical Practice Guidelines. Click here for a full list of topics.

Summary of Evidence: Gastrostomy

Date: 2013
Synopsis: These are Summaries of Evidence from our Canadian Critical Care Nutrition Clinical Practice Guidelines. Click here for a full list of topics.

Summary of Evidence: other formulas

Date: 2013
Synopsis: These are Summaries of Evidence from our Canadian Critical Care Nutrition Clinical Practice Guidelines. Click here for a full list of topics.

Summary of Evidence: Combination EN + PN

Date: 2013
Synopsis: These are Summaries of Evidence from our Canadian Critical Care Nutrition Clinical Practice Guidelines. Click here for a full list of topics.

Summary of Evidence: Composition of PN : Early vs delayed supplemental PN

Date: 2013
Synopsis: These are Summaries of Evidence from our Canadian Critical Care Nutrition Clinical Practice Guidelines. Click here for a full list of topics.

Summary of Evidence: PN vs Standard Care

Date: 2013
Synopsis: These are Summaries of Evidence from our Canadian Critical Care Nutrition Clinical Practice Guidelines. Click here for a full list of topics.

Summary of Evidence: Composition of PN: Branched Chain Amino Acids

Date: 2013
Synopsis: These are Summaries of Evidence from our Canadian Critical Care Nutrition Clinical Practice Guidelines. Click here for a full list of topics.

Summary of Evidence: Composition of PN : Type of lipids

Date: 2013
Synopsis: These are Summaries of Evidence from our Canadian Critical Care Nutrition Clinical Practice Guidelines. Click here for a full list of topics.

Summary of Evidence: Composition of PN : Zinc

Date: 2013
Synopsis: These are Summaries of Evidence from our Canadian Critical Care Nutrition Clinical Practice Guidelines. Click here for a full list of topics.

Summary of Evidence: Composition of PN : Parenteral Glutamine Supplementation

Date: 2013
Synopsis: These are Summaries of Evidence from our Canadian Critical Care Nutrition Clinical Practice Guidelines. Click here for a full list of topics.

Summary of Evidence: Composition of PN : Combined Parenteral and Enteral Glutamine Supplementation

Date: 2013
Synopsis: These are Summaries of Evidence from our Canadian Critical Care Nutrition Clinical Practice Guidelines. Click here for a full list of topics.

Summary of Evidence: PN Dose

Date: 2013
Synopsis: These are Summaries of Evidence from our Canadian Critical Care Nutrition Clinical Practice Guidelines. Click here for a full list of topics.

Summary of Evidence: PN: Use of Lipids

Date: 2013
Synopsis: These are Summaries of Evidence from our Canadian Critical Care Nutrition Clinical Practice Guidelines. Click here for a full list of topics.

Summary of Evidence: PN: Mode of Lipid Delivery

Date: 2013
Synopsis: These are Summaries of Evidence from our Canadian Critical Care Nutrition Clinical Practice Guidelines. Click here for a full list of topics.

Summary of Evidence: PN: Optimal glucose control: insulin therapy

Date: 2013
Synopsis: These are Summaries of Evidence from our Canadian Critical Care Nutrition Clinical Practice Guidelines. Click here for a full list of topics.

Summary of Evidence: PN: Optimal glucose control: carbohydrate restricted formula and insulin therapy

Date: 2013
Synopsis: These are Summaries of Evidence from our Canadian Critical Care Nutrition Clinical Practice Guidelines. Click here for a full list of topics.

Summary of Evidence: PN Antioxidants

Date: 2013
Synopsis: These are Summaries of Evidence from our Canadian Critical Care Nutrition Clinical Practice Guidelines. Click here for a full list of topics.

Summary of Evidence: PN Selenium

Date: 2013
Synopsis: These are Summaries of Evidence from our Canadian Critical Care Nutrition Clinical Practice Guidelines. Click here for a full list of topics.

Summary of Evidence: Vitamin D

Date: 2013
Synopsis: These are Summaries of Evidence from our Canadian Critical Care Nutrition Clinical Practice Guidelines. Click here for a full list of topics.

                                Training Materials                               

Best of the Best Poster - New Survey Participants

Date: 01/08/2009
Synopsis: This is a template for a poster designed to advertise the International Nutrition Survey for ICUs who are planning to participate for the first time.

PERFECTIS "WANTED" Poster

Creator: Naomi Cahill and Lauren Murch
Date: Summer 2010
Synopsis: This is a template for a poster designed to increase awareness of the importance of optimal nutrition practices

Best of the Best Poster - Returning Survey Participants

Date: 01/08/2009
Synopsis: This is a template of a poster designed to advertize the International Nutrition Survey for ICUs who have previously participated and are planning to participate in the next survey.

Clinical Practice Guidelines Poster

Date: 2009
Synopsis: This poster developed in collaboration with Nestle Canada highlights key clinical practice guideline recommendations.

Clinical Practice Guidelines Screensaver

Date: 2009
Synopsis: The screensaver consists of a slideshow highlighting some of the key clinical practice guidelines e.g. early EN, use of feeding protocols, head of bed elevation. This messages are intended to be uploaded on to computers to act as remiders to bed-side staff.

Interactive Workshop Assessment Handout

Synopsis: The Interactive Workshop Assessment Handout is a form that will enable you to collect feedback from your workshop, including what people learned and if/how they intend to change practices. Related tool: The Interactive Workshop Guide will help you plan and execute a workshop.

Interactive Workshop Guide

Synopsis: This is a step-by-step guide to conducting your own interactive workshop in your ICU, where the goal is to problem solve and identify strategies for improvement of nutrition practices. Related tool: The Interactive Workshop Assessment Handout will allow you to collect feedback from your workshop.

Pre-Printed Order

Date: 2009
Synopsis: This feeding protocol includes a pre-printed order and algorithm to guide the provision of enteral nutrition.

Presentation: "Early Enteral Nutrition in the ICU: The Clock Is Ticking!"

Date: 2009
Synopsis: You can view Dr Daren Heyland's "Early Enteral Nutrition in the ICU: The Clock Is Ticking!" presentation online. Thanks to Nestle for their help in making this available. After viewing this presentation, the participant will be able to evaluate ways of improving clinical care nutrition practices in the ICU, identify the risks and benefits of early enteral nutrition, and discuss strategies to optimize the delivery of enteral nutrition.

Sample Site Report

Date: 01/03/2010
Synopsis: This is an example of a benchmarked nutrition performance report received by participants of the International Nutrition Survey. Click here for more information about the survey.

Template for QI Poster

Synopsis: This is a template for a poster to communicate information regarding nutrition therapy at your ICU. We have a few different templates for QI Posters available. Feel free to download them and adapt them to your site, and use them to make everyone in your ICU aware of your nutrition performance, and any QI initiatives you are currently working on!