[Show abstract][Hide abstract] ABSTRACT: Parenteral nutrition (PN) is a high-risk nutrition support modality. This article describes the approach taken by 1 hospital to improve safety and quality of this therapy as well as the challenges and obstacles to success. Process improvement strategies included revisions to the PN order form, education of clinicians (including physicians), increased collaboration between pharmacists and registered dietitians, and initiation of PN rounds during which PN patients were reviewed by the rounding team twice weekly. These strategies were spearheaded by clinicians with advanced certifications in nutrition support. These process changes positively impacted quality and costs. Comparison of baseline and follow-up data showed improvement in compliance to mandatory safe practice standards, percentage of patients with appropriate indication for PN, adequote glycemic management, number of patients receiving PN within 10% of calorie needs, and appropriate laboratory monitoring. In addition to quality improvement, substantial cost savings were realized through decreased inappropriate PN use and timely transition to oral or enteral feeding. The average number of patients receiving PN decreased from approximately 15 to less than 5 per day. Overall, this translated into a $5.3 million decrease in PN charges. Actual pharmacy expenses decreased by $107,000. This quality improvement project demonstrated that implementing practice guidelines published by the American Society for Parental and Enteral Nutrition can result in quality improvement and cost savings. Clinicians with advanced certifications in nutrition support were pivotal to the success of the project.
Nutrition in Clinical Practice 12/2010; 25(6):663-71. DOI:10.1177/0884533610385349 · 2.40 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: All long-term care facilities are supposed to engage in quality improvement activities in an effort to improve care quality. The purpose of this pilot study was to teach long-term care staff how to conduct continuous quality improvement (CQI) related to nutritional care.
Research staff conducted CQI training in one 48-bed pilot site with designated staff members. Supervisory staff were taught a standardized direct observational protocol, which was implemented weekly by both facility and research staff, to monitor defined nutritional care processes under the control of direct care staff. In addition, direct care staff received feedback on a weekly basis about care process implementation.
Following initial training and 12 weeks of CQI implementation, there were improvements in all 5 nutritional care processes related to the adequacy and quality of daily feeding assistance care provision according to both facility and research staff data. Weekly CQI implementation required approximately 1 hour of supervisory staff time and less than 15 minutes of direct care staff time to receive feedback.
Both initial training and weekly CQI implementation were effective and required less than 2 hours of total staff time per week. Long-term care staff in this pilot site were able to improve nutritional care quality using a standardized direct observational protocol to guide CQI activities.
Journal of the American Medical Directors Association 11/2006; 7(8):480-5. DOI:10.1016/j.jamda.2006.03.002 · 4.94 Impact Factor
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