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  • Measure Summary
  • NQMC:008490
  • Mar 2011

Metabolism and nutrition: percentage of patients with indications for parenteral nutrition (PN).

Quality indicators in critically ill patients. Madrid (Spain): Spanish Society of Intensive and Critical Care and Units Coronary (SEMICYUC); 2011. 185 p.

View the original measure documentation External Web Site Policy

This is the current release of the measure.

The measure developer reaffirmed the currency of this measure in May 2016.

Primary Measure Domain

Related Health Care Delivery Measures: User-enrollee Health State

Secondary Measure Domain

Does not apply to this measure

Description

This measure is used to assess the percentage of patients with indications for parenteral nutrition (PN).

Rationale

The aim of intensive care medicine is to provide critical patients with the healthcare that they need, ensuring the quality and safety of care. Intensive care medicine is one of the principal components of modern healthcare systems. There is an increasing demand for this resource, which involves high costs.

The quality of care has gradually come to be the central focus of healthcare, and in recent years patient safety has come to represent one of the key aspects of quality. In the case of intensive care medicine, this interest in quality is even more evident, not only because of its social and economic impact, but also because some of the dimensions involved in the quality of care of critical patients take on greater importance: critical patients are more vulnerable, access to critical care is more limited so efforts to distribute resources equitably are more important, scant scientific evidence is available, and the efficiency is limited.

Nutritional support is essential in critical patients to avoid rapid undernourishment due to metabolic stress. Parenteral nutrition (PN) is the alternative when a feeding tube cannot be used partly or completely for any reason. The objective of PN is to supply the macronutrients or micronutrients to meet the nutritional needs of the critical patient. PN can provide 100% of the calories required or it can be administered as a complement to enteral nutrition (EN).

Evidence for Rationale

Bonet A, Grau T, Grupo de Trabajo de Metabolismo y Nutricion de la Sociedad Espanola de, Medicina Intensiva Critica y Unidades Coronarias. [Multicenter study on incidence of total parenteral nutrition complications in the critically-ill patient. ICOMEP study. Part I]. Nutr Hosp. 2005 Jul-Aug;20(4):268-77. PubMed External Web Site Policy

Quality indicators in critically ill patients. Madrid (Spain): Spanish Society of Intensive and Critical Care and Units Coronary (SEMICYUC); 2011. 185 p.

Singer P, Berger MM, Van den Berghe G, Biolo G, Calder P, Forbes A, Griffiths R, Kreyman G, Leverve X, Pichard C, ESPEN. ESPEN Guidelines on Parenteral Nutrition: intensive care. Clin Nutr. 2009 Aug;28(4):387-400. PubMed External Web Site Policy

Primary Health Components

Metabolism; parenteral nutrition (PN)

Denominator Description

Total number of patients that need artificial nutrition (see the related "Denominator Inclusions/Exclusions" field)

Numerator Description

Number of patients with indications for parenteral nutrition (PN) (see the related "Numerator Inclusions/Exclusions" field)

Type of Evidence Supporting the Criterion of Quality for the Measure

  • A clinical practice guideline or other peer-reviewed synthesis of the clinical research evidence
  • A formal consensus procedure, involving experts in relevant clinical, methodological, public health and organizational sciences
  • One or more research studies published in a National Library of Medicine (NLM) indexed, peer-reviewed journal

Additional Information Supporting Need for the Measure

Unspecified

Extent of Measure Testing

Unspecified

State of Use

Current routine use

Current Use

Internal quality improvement

Measurement Setting

Hospital Inpatient

Intensive Care Units

Professionals Involved in Delivery of Health Services

Physicians

Least Aggregated Level of Services Delivery Addressed

Single Health Care Delivery or Public Health Organizations

Statement of Acceptable Minimum Sample Size

Unspecified

Target Population Age

Age greater than or equal to 18 years

Target Population Gender

Either male or female

IOM Care Need

Not within an IOM Care Need

IOM Domain

Not within an IOM Domain

Case Finding Period

Unspecified

Denominator Sampling Frame

Patients associated with provider

Denominator (Index) Event or Characteristic

Clinical Condition

Denominator Time Window

Does not apply to this measure

Denominator Inclusions/Exclusions

Inclusions
Total number of patients that need artificial nutrition

Population: All patients admitted to critical care who need artificial nutrition.

Exclusions
Unspecified

Exclusions/Exceptions

Unspecified

Numerator Inclusions/Exclusions

Inclusions
Number of patients with indications for parenteral nutrition (PN)

Note: Indications for PN:

  • All patients admitted to the intensive care unit (ICU) without prospects of obtaining nutrition from oral or enteral feeding in 3 days
  • Bowel rest
  • Hypercatabolism and severe metabolic stress if enteral nutrition (EN) is insufficient
  • To complement inadequate oral or enteral nutrition for any reason

Exclusions
Unspecified

Numerator Search Strategy

Institutionalization

Data Source

Electronic health/medical record

Paper medical record

Type of Health State

Clinically Diagnosed Condition

Instruments Used and/or Associated with the Measure

Unspecified

Measure Specifies Disaggregation

Does not apply to this measure

Scoring

Rate/Proportion

Interpretation of Score

Does not apply to this measure (i.e., there is no pre-defined preference for the measure score)

Allowance for Patient or Population Factors

Unspecified

Standard of Comparison

Internal time comparison

Prescriptive standard

Prescriptive Standard

Standard: According to ICOMEP, 25% of patients admitted to critical care

Evidence for Prescriptive Standard

Bonet A, Grau T, Grupo de Trabajo de Metabolismo y Nutricion de la Sociedad Espanola de, Medicina Intensiva Critica y Unidades Coronarias. [Multicenter study on incidence of total parenteral nutrition complications in the critically-ill patient. ICOMEP study. Part I]. Nutr Hosp. 2005 Jul-Aug;20(4):268-77. PubMed External Web Site Policy

Quality indicators in critically ill patients. Madrid (Spain): Spanish Society of Intensive and Critical Care and Units Coronary (SEMICYUC); 2011. 185 p.

Original Title

Appropriate use of parenteral nutrition.

Measure Collection Name

Quality Indicators in Critically Ill Patients

Measure Set Name

Metabolism and Nutrition

Submitter

Spanish Society of Intensive and Critical Care and Units Coronary - Clinical Specialty Collaboration

Developer

Spanish Society of Intensive and Critical Care and Units Coronary - Clinical Specialty Collaboration

Funding Source(s)

Boehringer Laboratories

Composition of the Group that Developed the Measure

Work Group for Metabolism and Nutrition

  • Alfonso Mesejo Arizmendi
  • Clara Vaquerizo Alonso
  • Teodoro Grau Carmona
  • Alfons Bonet Sáris
  • Carlos Ortiz Leyba
  • Pilar Martínez García
  • Jimena Abilés
  • José Andrés Arboleda
  • Encarnación Molina Domínguez
  • Juan Carlos Montejo González
  • Carmen Sánchez Álvarez
  • Francisco Fernández Ortega
  • José Acosta Escribano
  • Ignacio Herrero Meseguer
  • Sergio Ruiz Santana

Scientific Coordination:

  • Maria Cruz Martín Delgado
  • Jesús Blanco Varela
  • Lluís Cabré Pericas
  • Pedro Galdos Anuncibay
  • Federico Gordo Vidal

Financial Disclosures/Other Potential Conflicts of Interest

Unspecified

Adaptation

This measure was not adapted from another source.

Date of Most Current Version in NQMC

2011 Mar

Measure Maintenance

Unspecified

Date of Next Anticipated Revision

2016 Jul

Measure Status

This is the current release of the measure.

The measure developer reaffirmed the currency of this measure in May 2016.

Source(s)

Quality indicators in critically ill patients. Madrid (Spain): Spanish Society of Intensive and Critical Care and Units Coronary (SEMICYUC); 2011. 185 p.

Measure Availability

Source available in English External Web Site Policy and Spanish External Web Site Policy from the Spanish Society of Intensive and Critical Care and Units Coronary (SEMICYUC) Web site.

For more information, contact SEMICYUC at Paseo de la Reina Cristina, 36, 4o D, Madrid, Spain; Phone: +34-91-502-12-13; Fax: +34-91-502-12-14; Web site: www.semicyuc.org External Web Site Policy; E-mail: secretaria@semicyuc.org.

NQMC Status

This NQMC summary was completed by ECRI Institute on January 6, 2014. The information was verified by the measure developer on February 26, 2014.

The information was reaffirmed by the measure developer on May 10, 2016.

Copyright Statement

This NQMC summary is based on the original measure, which is subject to the measure developer's copyright restrictions.

The Quality Indicators in Critically Ill Patients update 2011 can be used by any private or public body only for the purposes of research, clinical management, teaching and education, and will not be used for any other purpose. In all cases, full credit to the Spanish Society of Intensive Care Medicine (SEMICYUC) will be granted. The commercial use of the Quality Indicators in Critically Ill Patients update 2011 is explicitly forbidden.

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