Ibero-Latin-American Section – Ilas – Nursing. 06 No. 1
* Free works presented at ILAS – IBERO-LATIN-AMERICAN SECTION 27th
American Society of Parenteral and Enteral Nutrition – ASPEN
Clinical Congress San Antonio, Texas USA. TUESDAY, JANUARY 21, 2003.
“Design of a Software Application to Assist the Physician on the Assessment of Metabolic Requirements, Parenteral/Enteral Formulation and Monitoring of Patients with Nutrition Support”
Victor C. Hayakawa-Dávila. José Antonio Ruy-Díaz R, Juan C. Marquez H., Enrique Montaño, Fernando González.
Division of Metabolic and Nutritional Support and the Department of Research Design and Analysis from the “Dr. Manuel Gea González” General Hospital (SS), Mexico, DF
Department of Nutrition and Metabolism from the Anahuac University, School of Medicine. Mexico DF
Like most hospitals with an advanced nutritional support clinic, the “Dr. Manuel Gea Gonzalez” General Hospital, attends a high volume of patients who require continuous attention and close monitoring. This translates into a great expenditure of time and effort from the nutritional support team. In order to improve the quality and efficiency of our attention, we developed several tools that evolved up to the design of a software application. This program is capable of creating a database for capturing patient’s ID and anthropometric data, laboratory test results, nutrition and calorimetric parameters. It presents some of the most significant empirical formulas for the estimation of rest energy expenditure and hydro-electrolytic needs. The software is capable of making all those time consuming calculations for prescription and compounding of the parenteral nutrition orders. As well, it offers a wide variety of enteral commercial products. Shows graphically and objectively, the evolution of the most representative nutritional and laboratory parameters, for the on-going assessment of the metabolic and nutritional status and for surveillance and early detection of complications.
It is important to emphasize that this Software is intended for qualified personnel. It does not in any way substitute the physician’s criteria. It does not indicate what patients require metabolic or nutritional support, the kind of support or the administration route.
The Effectiveness of the Establishment of Clinical Practice Guidelines (CPG) on the Use of Parenteral Nutrition in a Tertiary Pediatric Hospital.
Christopher Duggan, Camielle Rizzo, Andrew Cooper Susan Klavon, Vanessa Fuchs, Kathleen Gura, Denise Richardson, Sharon Collier, Clifford Lo.
Department of Gastroenterology and Nutrition, The Children’s Hospital, Boston.
Objective: To determine the effectiveness of a clinical practice guideline (CPG) on the use of parenteral nutrition (PN) at a tertiary care pediatric hospital.
Methods: Review of prospectively collected data on hospital-wide PN use two years before and five years after the establishment of the CPG. Effectiveness of the CPG was measured as the percentage of PN courses lasting less than 5 days, as well as the number of PN starts per 1000 patient days.
Results: During the study period, 5,745 PN courses were administered. The mean (SD) number of PN starts per 1000 inpatient days was 8.86 (0.78) before the CPG and 9.54 (2.49) afterwards (p = 0.28). The percentage courses of PN lasting for fewer than 5 days declined from 26.3% before the CPG to 18.4 % afterwards (OR: 0.63 (0.55-0.72); p < 0.0001). A multivariate model confirmed that the rate of short-term PN starts declined after the CPG was issued. The mean (SD) number of PN courses shorter than 5 days in the two years before the CPG was 2.33 (0.42) per 1000 patient days versus 1.75 (0.45) in the 5 years after the CPG was instituted (p = 0.005), a 25% decline. The services with the highest volume of PN use (surgery, cardiology, hematology/oncology) showed the most significant decreases in short-term PN use, while those that had the smaller volume of PN starts had less significant decreases (intensive care units, medical subspecialties, general pediatrics).
Conclusions: In a large pediatric tertiary care hospital, a CPG was successfully deployed. The introduction of the CPG was associated with no overall change in PN use, but the occurrence of short-term use of PN (less than 5 days duration) declined by 25%. CPGs can favorably affect the utilization rates of parenteral nutrition.
Dietary Quantification – A Valid Instrument to Identify Patients at Risk of Malnutrition
KCG. Araújo, D. Carvalho, P. Brito, JB. Álvares, FRF Maia, IK. Fonseca, J. Guimarães, LC. Matos, EB. Cabral, MIDD. Correia
The nutritional status of hospitalized patients is important to determine the success of the evolution and the quality of life of these patients. The fact that the patient has the oral route cleared does not mean that he is eating what he really needs.
Aim: To evaluate the nutrient intake of patients at risk of malnutrition, with feeding on demand by mouth.
Method: Analytical observational study. 194 patients were evaluated through the 24-hour recall technique, followed for more than 2 days. The calculation of the nutritional needs of these patients was 25-30 Kcal/Kg/current weight and 1.0-1.3 g/Kg of protein/day, according to the patient’s illness. 5.2% of the patients were also receiving enteral nutrition and 41.1% were prescribed high-calorie and high-protein supplements, two to three times a day (content of 600 to 1050 Kcal/day and 24 to 54 g of protein/day). . 53.7% did not receive any nutritional supplement, only the diet prescribed by the doctor. Statistical analysis was done through the Kruskal-Wallis test of variance.
Results: The average age was 56.6 + 19.2 years (11 to 95 years), with 52.1% male. In 60.8% the prescribed diet was free/soft; 11.9% special diet (diabetes, kidney failure, low sodium) and 27.3% complete pasty/liquid diet. The average daily intake was 67.5 + 33.6% relative to nutritional estimates for calories and 74.4 + 33.6% for protein. Still, in 25% of the patients the intake was less than 50% of the calculated nutritional value and only 25% of the patients received more than 81.5% of the calories and 103% of the estimated proteins (p<0. 05). There was no statistical difference between nutrient intake according to the type of diet consumed (free x pasty x special).
Conclusion: Through dietary surveillance, it was possible to identify that up to 50% of patients were unable to meet the calculated nutritional needs, even though some were using nutritional supplements. However, these patients must then receive enteral nutrition.
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