Clinical Decision Support Tools and a Standardized Order Set Enhances Early Enteral Nutrition in Critically Ill Children.
Algorithms
Clinical Protocols
Cohort Studies
Critical Care
/ methods
Critical Illness
/ therapy
Decision Support Systems, Clinical
Electronic Health Records
Enteral Nutrition
/ methods
Female
Humans
Infant
Infant, Newborn
Intensive Care Units, Pediatric
Length of Stay
Male
Quality Improvement
Time Factors
child
critical illness
electronic health records
enteral nutrition
nutrition support
pediatric intensive care unit
pediatrics
quality improvement
Journal
Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition
ISSN: 1941-2452
Titre abrégé: Nutr Clin Pract
Pays: United States
ID NLM: 8606733
Informations de publication
Date de publication:
Dec 2019
Dec 2019
Historique:
pubmed:
2
4
2019
medline:
11
4
2020
entrez:
2
4
2019
Statut:
ppublish
Résumé
Critically ill children in a pediatric intensive care unit (PICU) have unique nutrition needs that are challenging to achieve and thus are at high risk of malnutrition. There is increasing evidence that children who reach caloric goals early have improved outcomes. The purpose of this initiative was to implement an enteral nutrition (EN) algorithm in a tertiary care PICU utilizing clinical decision support tools (CDSTs) and a standardized order set within an electronic health record. A quality improvement initiative was undertaken to implement an EN feeding protocol using electronic CDSTs, including a new standardized order set. In a historical cohort of 376 patients, only 18% met goal EN in the first 48 hours of admission. The EN protocol was implemented in 272 patients who met 88% goal feed volume within 48 hours of intensive care unit admission. Median time to start EN (1.7 vs 1.3 days, P < 0.0001) and time to goal nutrition (2.8 vs 2.2 days, P < 0.001) improved after project implementation. Length of stay in the PICU was significantly reduced following protocol implementation (202 hours pre-implementation vs 156 hours post implementation, P < 0.0001). We used CDSTs and standardized order sets to implement a nutrition algorithm to facilitate and likely improve the nutrition care of critically ill children.
Sections du résumé
BACKGROUND
BACKGROUND
Critically ill children in a pediatric intensive care unit (PICU) have unique nutrition needs that are challenging to achieve and thus are at high risk of malnutrition. There is increasing evidence that children who reach caloric goals early have improved outcomes. The purpose of this initiative was to implement an enteral nutrition (EN) algorithm in a tertiary care PICU utilizing clinical decision support tools (CDSTs) and a standardized order set within an electronic health record.
METHODS
METHODS
A quality improvement initiative was undertaken to implement an EN feeding protocol using electronic CDSTs, including a new standardized order set.
RESULTS
RESULTS
In a historical cohort of 376 patients, only 18% met goal EN in the first 48 hours of admission. The EN protocol was implemented in 272 patients who met 88% goal feed volume within 48 hours of intensive care unit admission. Median time to start EN (1.7 vs 1.3 days, P < 0.0001) and time to goal nutrition (2.8 vs 2.2 days, P < 0.001) improved after project implementation. Length of stay in the PICU was significantly reduced following protocol implementation (202 hours pre-implementation vs 156 hours post implementation, P < 0.0001).
CONCLUSIONS
CONCLUSIONS
We used CDSTs and standardized order sets to implement a nutrition algorithm to facilitate and likely improve the nutrition care of critically ill children.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
916-921Informations de copyright
© 2019 American Society for Parenteral and Enteral Nutrition.
Références
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