KGH-developed website reaches ICUs around the world

New tool improves nutrition therapies for critically ill

Kingston General Hospital is providing global leadership by creating a forum for clinicians who treat the sickest patients in intensive care units (ICU).

Since 2004, the Critical Care Nutrition website, created by the Clinical Evaluation Research Unit at KGH, has focused on raising awareness about nutrition therapy research and practice. The website was re-launched in September after the research unit received a grant from the Canadian Institutes of Health Research (CIHR) to develop tools that enable health-care providers to implement best practice guidelines for nutrition therapy.

The CCN website was redesigned to be more visually engaging, easier to navigate and to encourage further collaboration among experts by profiling Canadian Clinical Practice Guidelines, ongoing research projects, as well as a new interface for accessing quality improvement tools.

As well, the research unit hosts international audits for participating ICUs to identify opportunities for improvements. Between 150 and 300 ICUs participate in the surveys that compare practices in ICUs within and across different countries.

“The surveys help highlight differences, strengths and weaknesses,” explains Clinical Evaluation Research Unit Director Dr. Daren Heyland. “In combination with our tools and strategies, we are then able to help improve nutrition practices to reduce mortality and complications.”

Daren says nutrition health-care providers in ICUs around the world know about the website and take advantage of their ability to browse, download, utilize and provide feedback.

Providing nutritional requirements for critical care patients can be challenging. What patients actually receive can range from 20 to 80 per cent of what is prescribed.  These challenges stem from varying methods of feeding as well as barriers created through the regular provision of health care. The KGH research team, Rupinder Dhaliwal, Naomi Cahill and Lauren Murch, is actively researching strategies to reduce these barriers and improve nutrition delivery.

Data submitted by ICUs is compiled and available online. Participants receive a feedback report, specific to their practices, outlining potential areas of improvement and illustrating nutrition practices of other ICUs. This process engages providers by highlighting their nutrition practices relative to evidence-based best practice guidelines.

“We’ve developed these guidelines to show how various nutritional interventions and feeding methods affect clinical outcomes,” says Daren. “Clinicians can compare these recommendations with their own practices to determine what they are doing well and how to incorporate improvements. ICUs everywhere develop strategies and tools but the website creates a community of sharing, which benefits patient care.”

Dr. Leah Gramlich uses the website all the time. The President of the Canadian Nutrition Society and Director of Nutrition Support Services at Royal Alexandra Hospital in Edmonton believes it is an invaluable resource.

“First and foremost, I use the website as a teaching tool for residents and fellows because it provides up-to-date and high quality information,” says Leah. “It provides trainees with a venue to look up clinical practice guidelines and for me to work with them and experienced clinicians to interpret the literature and determine what is best for our patients.”

After participating in the audit, Leah’s team takes the feedback to evaluate their current practices and develop strategies for the future.

“Every health-care practitioner knows about nutrition but may not realize that there is such strong evidence to support the use of nutrition therapy,” says Leah. “This evidence is nicely summarized and catalogued on the website.”

Leah credits strong leadership and a strong connection between research and practice in the KGH ICU for ensuring critically ill patients receive an average of 80-90 percent of their nutritional requirements.

Support for nutrition therapy in critically ill patients is certainly not always immediate or unanimous. Daren says every ICU is different and follows specific nutrition therapy protocols based on their own perception of best practices.

“All the available resources on the website are geared to help ICUs discover what others are doing – what works and what may work better,” says Daren. “This collaborative tool addresses patients’ needs while supporting risk reduction practices that reduce mortality rates, improve clinical outcomes for critically ill patients, and save health-care dollars.” 

Daren credits the audit and feedback components of the website for helping validate the importance of critical care nutrition therapy and for engaging such a vast number of stakeholders around the world. The next survey is planned for May 2011.

For more information, visit the website at www.criticalcarenutrition.com.