Factors predicting adherence to the Canadian Clinical Practice Guidelines for nutrition support in mechanically ventilated, critically ill adult patients

Jones, Naomi E.; Dhaliwal, Rupinder; Day, Andrew G.; Ouellette-Kuntz, Hélène; Heyland, Daren K.

doi:10.1016/j.jcrc.2007.08.004

« Previous Next »Journal of Critical Care
Volume 23, Issue 3 , Pages 301-307, September 2008

Factors predicting adherence to the Canadian Clinical Practice Guidelines for nutrition support in mechanically ventilated, critically ill adult patients☆

Naomi E. Jones, MSc
- Department of Community Health and Epidemiology, Queen’s University, Kingston, ON, Canada K7L 3N6
- Clinical Evaluation Research Unit, Kingston General Hospital, Kingston, ON, Canada K7L 2V7
Rupinder Dhaliwal, RD, BASc
- Clinical Evaluation Research Unit, Kingston General Hospital, Kingston, ON, Canada K7L 2V7
Andrew G. Day, MSc
- Clinical Evaluation Research Unit, Kingston General Hospital, Kingston, ON, Canada K7L 2V7
Hélène Ouellette-Kuntz, MSc, RN
- Department of Community Health and Epidemiology, Queen’s University, Kingston, ON, Canada K7L 3N6
Daren K. Heyland
- Department of Community Health and Epidemiology, Queen’s University, Kingston, ON, Canada K7L 3N6
- Clinical Evaluation Research Unit, Kingston General Hospital, Kingston, ON, Canada K7L 2V7
- Department of Medicine, Queen’s University, Kingston, ON, Canada K7L 3Z6
- Corresponding author. Kingston General Hospital, Kingston, ON, Canada K7L 2V7. Tel.: +1 613 549 6666x3339; fax: +1 613 548 1351.

published online 06 December 2007.

Abstract

Purpose

The aim of this study was to determine factors that are associated with adherence to the Canadian nutrition support clinical practice guidelines (CPGs).

Materials and Methods

We conducted a secondary analysis of data from a prospective observational cohort study of nutrition support practices in 58 intensive care units (ICUs) across Canada, grouped into 50 clusters. Adequacy of enteral nutrition (EN) (energy received from EN ÷ energy prescribed by the dietitian × 100), was used as a marker of adherence to the guidelines. We applied hierarchical modeling techniques to examine the impact of various hospital, ICU, and patient factors on EN adequacy.

Results

The overall average EN adequacy was 51.3% (SE, 1.8%). In a multiple regression analysis, after adjusting for varying days of observation, hospital type (academic 54.3% vs community 45.2%, P < .001), admission category of the patient (medical 60.2% vs surgical 39.2%, P < .001), and sex of the patient (male 46.5% vs female 52.8%, P < .001) were found to be significant predictors of EN adequacy and adherence to the Canadian nutrition support CPGs.

Conclusions

Specific hospital, ICU, and patient characteristics influence adherence to the Canadian nutrition support CPGs. Further research is required to illuminate the mechanisms by which female and surgical patients and community hospitals lead to lower guideline adherence.

Keywords: Clinical practice guidelines, Guideline adherence, Nutrition support, Enteral nutrition, Critical care