Revista Brasileira de Terapia Intensiva (Dec 2009)
Terapia nutricional enteral: aplicação de indicadores de qualidade Enteral nutritional therapy: application of quality indicators
Abstract
OBJETIVOS: Monitorar a adequação da terapia nutricional enteral na unidade de terapia intensiva visando à melhoria da qualidade da assistência nutricional. MÉTODOS: Estudo prospectivo e observacional desenvolvido na unidade de terapia intensiva adulto entre 2005 e 2008. Participaram da amostra pacientes maiores de 18 anos com terapia nutricional enteral exclusiva por mais de 72h. Analisou-se os valores médios e a adequação percentual de energia e proteínas calculados, prescritos e administrados em cada ano. Os fatores responsáveis pela não conformidade na administração planejada foram classificados em causas externas ou internas à unidade de terapia intensiva. Foram aplicados os indicadores de qualidade propostos pelo International Life Sciences Institute (ILSI) Brasil, sendo expressos em metas percentuais. Nas análises estatísticas utilizou-se o intervalo de confiança e os testes t Student e Mann-Whitney (pOBJECTIVE: Monitor the adequacy of enteral nutritional therapy at the intensive care unit aiming to improve the quality of nutritional assistance. METHODS: Prospective and observational study developed at the adult intensive care unit from 2005 to 2008. Patients over 18 years of age with exclusive enteral nutritional therapy for over 72h participated in the sample. The average values and the percentile adequacy of energy and proteins calculated, prescribed and administered in each year were analyzed. The factors responsible for the non-conformity of the administration planned were classified into intensive care unit extrinsic or intrinsic causes. The quality indicators proposed by the ILSI Brazil were applied, and expressed into percentile goals. In the statistic analyses, confidence interval and the t Student e Mann-Whitney (p<0.05) tests were used, according to the Epi Info program. RESULTS: One hundred and sixteen patients were followed up. There were statically difference in values of energy and protein administered in 2005 and in 2006, when compared to those in 2008. The adequacy calculated/prescribed remained close to 100% in all the surveys and the adequacy administered/prescribed increased from 74% in 2005, to 89% in 2008. An increase in interruptions of enteral nutritional therapy for external factors and the decrease in interruptions for intensive care unit internal factors were verified. The quality indicators equally reflect the evolution of the patient care. CONCLUSION: In the four yearly surveys, a progressive enhancement of nutritional support was verified. Quality indicators allow nutritional care evolution monitoring, the comparison to other services data, and are a new perspective for enteral nutritional therapy assessment.
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