Jpen Parenter Enter
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Jpen Parenter Enter · Nov 2010
Multicenter StudyThe value of audit and feedback reports in improving nutrition therapy in the intensive care unit: a multicenter observational study.
The objective of this study was to determine whether auditing practice and providing feedback in the form of benchmarked site reports is an effective strategy to improve adherence to nutrition guidelines. ⋯ Audit and feedback reports are associated with improvement in some nutrition practices in many ICUs; however, the magnitude of these effects is quite modest. More research is needed to determine the optimal methods of using audit and feedback to improve quality of nutrition care.
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Critical care nutrition guidelines have been developed to help busy practitioners decide how to feed their critically ill patients. However, despite the publication of guidelines and efforts to disseminate and implement them, there are large gaps between what the recommendations say and what is happening at the bedside. Consequently, the nutrition therapy received by many patients remains suboptimal. ⋯ The action component consists of 8 phases of the action cycle that represent activities needed to move knowledge into practice and are derived from planned-action theory. Components of this model are illustrated via empirically derived research, commentaries, and published studies from the field of critical care nutrition. It is hoped that this article and related articles in this issue of JPEN will help critical care nutrition practitioners to better understand the often complex and convoluted road of translating knowledge into practice so that as a community we are no longer "lost" but have direction that can bring about positive changes in nutrition practice.
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Jpen Parenter Enter · Nov 2010
Compilation of recommendations from summit on increasing physician nutrition experts.
This report compiles the list of recommendations derived from the Summit on Increasing Physician Nutrition Experts. The recommendations represent expert opinion on topics related to increasing the number of physicians who choose nutrition as a career option and on topics related to strengthening multidisciplinary educational programs, research activity, and clinical practice in nutrition in the future. The recommendations should not be interpreted to represent consensus, approval, or endorsement by attendees or participating societies. ⋯ Many of these recommendations are already being acted upon by various groups within the participating societies. The listing of recommendations does not imply responsibility for implementation by Summit attendees. The role for any council arising from this Summit is yet to be defined but may certainly involve facilitating communication and collaboration of initiatives arising from many of the issues listed here.
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Jpen Parenter Enter · Nov 2010
ReviewBridging the guideline-practice gap in critical care nutrition: a review of guideline implementation studies.
Several clinical practice guidelines focusing on nutrition therapy in mechanically ventilated, critically ill patients are available to assist busy critical care practitioners in making decisions regarding feeding their patients. However, large gaps have been observed between guideline recommendations and actual practice. To be effective in optimizing nutrition practice, guideline development must be followed by systematic guideline implementation strategies. ⋯ These studies demonstrated small improvements in nutrition practice, but no significant effect on patient outcomes. There are some data to suggest that tailoring guideline implementation strategies to overcome identified barriers to change might be a more effective approach than the multifaceted "one size fits all" strategy used in previous studies. Adopting this tailored approach to guideline implementation in future studies may help bridge the current guideline-practice gap and lead to significant improvements in nutrition practices and patient outcomes.
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Jpen Parenter Enter · Nov 2010
Understanding adherence to guidelines in the intensive care unit: development of a comprehensive framework.
Clinical practice guidelines (CPGs) have been hailed as a useful method of translating evidence into practice. Several CPGs have been published that provide recommendations for feeding patients in the intensive care unit (ICU). Despite a rigorous development process and active dissemination of these guidelines, their impact on nutrition practice has been modest. The purpose of this study was to develop a comprehensive framework for understanding adherence to nutrition CPGs in the critical care setting. ⋯ Adherence to nutrition CPGs is determined by a complex interaction of multiple factors that act as barriers or enablers. The comprehensive framework for adherence to CPGs in the ICU attempts to elucidate this process and provides a useful template for future research. Future quality improvement initiatives should assess local barriers to change and design interventions to overcome these barriers.