Quality Indicators in Enteral Nutrition Therapy: Application among Older Patients in an Intensive Care Unit

Feitosa, Gina Araújo Martins; Barbosa, Janine Maciel; Alves, Gislayne Azevedo de Campos; Oliveira, Narjara Cinthya Nobre de; Florêncio, Márcia Virgínia di Lorenzo; Pedrosa, Ivanilda Lacerda

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Original Articles • Rev. bras. geriatr. gerontol. 23 (5) • 2020 • https://doi.org/10.1590/1981-22562020023.200251 copy

Quality Indicators in Enteral Nutrition Therapy: Application among Older Patients in an Intensive Care Unit

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

to investigate the quality indicators in enteral nutritional therapy in older patients admitted to the intensive care unit of a university hospital in the city of João Pessoa, Paraíba.

Methods

a retrospective, cross-sectional study was carried out with older adults admitted to the intensive care unit between March 2018 and March 2019. The indicators used were the frequency of measurement of Body Mass Index (BMI) at admission; estimated energy expenditure and protein requirement; adequate administration of prescribed vs. infused volume; patients fasting before starting enteral nutritional therapy; diarrhea and constipation according to the parameters of the International Life Sciences Institute of Brazil. For the comparison between quality indicators and clinical outcomes (hospital discharge and death) and length of stay (≤14 and >14 days), the chi-square test was used, with associations with p<0.05 being considered significant.

Results

there were 79 older adults, with an average hospital stay of 14 days. Regarding the indicators, the frequency of BMI measurement at admission and the estimate of energy expenditure and protein requirement reached the targets. When analyzing the association of quality indicators with clinical outcomes, significant differences (p=0.010) were observed between the infused vs. prescribed volume indicator and hospital discharge.

Conclusion

the indicator of the frequency of adequate administration of prescribed vs. infused volume had a significant association with the outcome, suggesting that this indicator should be considered in monitoring nutritional assistance for older adults. It is therefore necessary to develop action plans to ensure the effectiveness of the processes, although more studies are also needed.

Keywords
Health of the Elderly; Nutrition Therapy; Intensive Care Units; Quality Indicators; Health Care

- Frequency of BMI measurement at admission in patients undergoing ENT: $\frac{Number of patients undergoing ENT with BMI measured at admission \times 100}{Total number of patients undergoing ENT}$ TARGET: >80%
- Frequency of measurement or estimate of energy expenditure and protein requirement in patients undergoing ENT: $\frac{No. of patients undergoing ENT with assessment of energy and protein expenditure \times 100}{Total number of patients undergoing ENT}$ TARGET = ≥ 80%
- Frequency of adequate administration of prescribed X infused volume in patients undergoing ENT: $\frac{Number of patients with proper ENT volume \times 100}{Total number of patients undergoing ENT}$ TARGET = ≥ 80%
- Frequency of patients fasting before starting early ENT: $\frac{No . of ENT candidates fasting> 48h \times 100}{Total number of patients undergoing ENT}$ TARGET = <20%
- Frequency of diarrhea in patients undergoing ENT: $\frac{No. of patients undergoing ENT with diarrhea \times 100}{Total number of patients undergoing ENT}$ TARGET = ≤ 10%
- Frequency of episodes of constipation in patients undergoing ENT: $\frac{No. of patients undergoing ENT with constipation \times 100}{Total number of patients undergoing ENT}$ TARGET = <20%

Variable	Mean	Median	±Standard- Deviation	Interquartile distance	n (%)
Age (years)*	72.5	71.0	9.4	(66.0-78.0)	-
Length of ICU stay (days) **	17.3	14.0	12.4	(8.0-20.0)	-
Duration of nutritional therapy**	12.4	9.0	10.9	(4.0-17.2)	-
Sex
Male		-			30 (38.0)
Female		-			49 (62.0)
Outcome
Discharge		-			44 (55.7)
Death		-			35 (44.3)

Indicators	Length of stay n (%)		p
Indicators	≤14 days	>14 days	p
Fasting			0.946^a
≤ 48h	30 (75.0)	28 (71.8)
> 48h	10 (25.0)	11 (28.2)
BMI			0.263^b
Measured	34 (85.0)	37 (94.9)
Not measured	6 (15.0)	2 (5.1)
EE estimate			0.116^b
Estimated	31 (77.5)	35 (89.7)
Not estimated	9 (22.5)	3 (7.7)
Missing*	0 (0.0)	1 (2.6)
Prescribed x infused volume *			0.052^a
Yes	15 (37.5)	26 (66.7)
No	21 (52.5)	13 (33.3)
Missing*	4 (10.0)	0 (0.0)
Episodes of diarrhea *			0.111^a
Yes	10 (25.0)	17 (43.6)
No	30 (75.0)	21 (53.8)
Missing*	0 (0.0)	1 (2.6)
Episodes of constipation			0.284^a
Yes	22 (55.0)	27 (69.2)
No	18 (45.0)	12 (30.8)

Indicators	Outcome n (%)		p
Indicators	Discharge	Death	p
Fasting			0.680^a
≤ 48h	31 (70.5)	27 (77.1)
> 48h	13 (29.5)	8 (22.9)
BMI			0.129^b
Measured	42 (95.5)	29 (82.9)
Not measured	2 (4.5)	6 (17.1)
EE estimate			0.356^b
Estimated	38 (86.4)	28 (80.0)
Not estimated	5 (11.3)	7 (20.0)
Missing*	1 (2.3)	0 (0.0)
Prescribed x infused volume *			0.010^a
Yes	29 (65.9)	12 (34.3)
No	13 (29.5)	21 (60.0)
Missing*	2 (4.6)	2 (5.7)
Episodes of diarrhea*			0.508^a
Yes	13 (29.5)	14 (40)
No	30 (68.2)	21 (60)
Missing*	1 (2.3)	0 (0.0)
Episodes of constipation			0.134^a
Yes	31 (70.5)	18 (51.4)
No	13 (29.5)	17 (48.6)

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[1] Correspondence Gina Araújo Martins Feitosa ginaamfeitosa@gmail.com