Enhanced enteral and parenteral nutrition practice and outcomes in an intensive care unit with a hospital-wide performance improvement process.

To improve patient outcomes at a 455-bed community health care facility, a performance improvement process was implemented for the delivery of enteral and parenteral nutrition in a 28-bed intensive care unit (ICU). In 1992, the study group consisted of all patients who were started on either enteral or parenteral nutrition while in the ICU during a 2-month period. These patients were followed up until discharge from the hospital or death to determine practice patterns and outcomes. Three actions were identified as opportunities to change practice and improve outcomes: increase use of the enteral route of alimentation compared with the parenteral route; start alimentation sooner, especially via the enteral route; and meet protein and energy needs of patients. Educational programs were developed targeting physician and nursing staff. Through an interdisciplinary approach, a nutrition support decision tree and patient outcome statement were developed. In 1994, evaluation of a group meeting the same criteria as the original group indicated that the goals for nutrition support practice improvement were met in all three areas identified. Providing a systematic approach to an interdisciplinary performance improvement process, as part of an organization-wide plan, enhanced nutrition support practice in a community hospital and resulted in quality improvement and cost savings.