Thesis (Mnutr)--Stellenbosch University, 2004. / ENGLISH ABSTRACT: Objective: To assess the impact of a continuous auditing process on nutritional
support in a tertiary paediatric intensive care unit.
Design: Prospective, longitudinal audit initiated in 1994. Re-auditing took place
almost every 2 years: 1994-1995, 1997-1998 and 2001, leading to completion of the
audit cycle.
Setting: An 8 bed Paediatric Intensive Care Unit (PICU) in StMary's Hospital
London.
Subjects: All ventilated patients admitted for more than a complete 24-hour period
were included in the audit. The units' standard daily fluid charts were used for data
collection. Data was collected until discharge from PICU or a maximum of 10 days.
Incomplete and imprecise data was disregarded during the data analysis process.
Outcome measures and interventions: The outcome measures include time taken to
initiate nutritional support, the route of feeding and delivery of calories by day 3,
judged by the Estimated Average Requirements (EAR) for energy. Feeding
algorithms and protocols introduced after each audit: nasogastric feeding algorithm
following the 1994-1995 audit, blind nasojejunal tube insertion technique and related
feeding algorithms after the audit in 1997-1998.
Results: Time taken to initiate enteral feeding was reduced from 15 hours (1994-
1995) to 5.5 hours (2001). The proportion of parenterally fed patients fell from 11%
(1994-1995) to 1% (200 1 ). The proportion of enterally fed patients via the nasojejunal
route rose from 1% (1994-1995) to 20% (2001). An increase was noticed in patients
reaching 50% and 70% of energy requirement by day 3 following admission was
documented: 7% in1994-1995 to 35% in 2001 for 70% of EAR (p = 0.0008) and 18% in 1994-1995 to 58% in 2001 for 50% of
EAR. (p< 0.0001)
Conclusion: This audit process demonstrates the effectiveness of continuous auditing
in an intensive care unit in improving the quality of nutritional support. This is
possible only with a multi-disciplinary team approach. / AFRIKAANSE OPSOMMING: Doel: Om die impak van 'n deurlopende ouditerings proses op die
voedingsondersteuning in 'n tersi~re pediatriese intensiewesorg-eenheid te evalueer.
· Studie Ontwerp: 'n Prospektiewe, longetudinale oudit is in 1994 geYnisieer.
Herouditee·ring het ongeveer elke 2 jaar plaasgevind: 1994-1995, 1997-1998 en 2001.
Dit het tot die voltooiing van 'n ouditering siklus gelei.
Plek: 'n Agt-bed Pediatriese lntensiewesorgeenheid (PISE) in StMary's Hospitaal
London, Engeland.
Pasiente: Alle geventilleerde pasiente wat opgeneem was vir !anger as 'n volledige
24 uur-periode is by die oudit ingesluit. Die eenheid se standard daaglikse vogkaarte
dokumentasie is gebruik vir data-insameling. Data-insameling het plaasgevind tot en
met ontslag vanuit die PISE vir 'n maksimum van 10 dae. Onvolledige en onakkurate
data is uitgesluit tydens die data analise proses.
Uitkomste en Intervensie: Die uitkomste is gemeet deur die impak van die
ouditerings proses te evalueer ten opsigte van tydsduur voordat daar voedings
geYnisieer is, die voedingsroete en die hoeveelheid energie gelewer teen dag 3,
vergelyk met die geskatte gemiddelde energie behoefte. Voedings-algoritmes en
protokolle is geYmplementeer na elke oudit: nasogastriese voedings-algoritmes is na
die 1994-1995 oudit geYmplimenteer, 'n blinde nasojejunale buisinplasingstegniek en
I
relevante voedings algoritmes het na die 1997-1998 oudit gevolg.
Resultate: Die tydsduur om voedingondersteuning te inisieer het van 15 ure (1994-
1995) tot 5.5 ure (2001) verminder. Die persentasie pasiente wat parenterale voeding
ontvang het, het gedaal van 11% (1994-1995) tot 1% (2001), met 'n toename in
enterale voeding via die nasojejunale roete van 1 %(1994) tot 20% (2001). 'n Toename in pasiente wat meer as 50% en 70% van hul energie behoefte bereik het
teen dag 3 is opgemerk: 7% in 1994-1995 en 35% in 2001 het meer as 70% van die
geskatte gemiddelde behoefte vir energie ontvang. (p=0.0008) Agtien persent het in
1994-1995 en 58% in 2001 meer as 50% van hul gemiddelde energie behoeftes bereik
(p < 0.0001).
Gevolgtrekking: Hierdie ouditerings proses demonstreer die effektiewiteit van
deurlopende ouditering in 'n intensiewesorg-eenheid deur die verbetering van die
kwalitiet van voedingondersteuning. Dit is slegs moontlik met 'n multidissiplinere
span benadering.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:sun/oai:scholar.sun.ac.za:10019.1/50156 |
| Date | 12 1900 |
| Creators | Meyer, Rosan Waltraut |
| Contributors | Labadarios, D., Schubl, Claudia, Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Interdisciplinary Health Sciences. Human Nutrition. |
| Publisher | Stellenbosch : Stellenbosch University |
| Source Sets | South African National ETD Portal |
| Language | en_ZA |
| Detected Language | Unknown |
| Type | Thesis |
| Format | xiv, 82 p. : ill. |
| Rights | Stellenbosch University |
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