1. Nutritional Practices in Critical Care
The Welsh Experience
Rhian Booth , Mike Slattery
WICS 2013

2. “ Let food be thy medicine and medicine be thy food”
Overview
Background
Method
Results
Summary
“ Let food be thy medicine and medicine be thy food”
Hippocrates 400 BC

3. Evidence/Guidelines

5. Underlying Pathophysiology Of Critical Illness
EN intake
Caloric debt associated with:
Longer ICU stay
Days on mechanical ventilation
Complications
Mortality

6. AIM
To determine the variation in assessment and provision of nutrition and its resource implications within the Welsh critical care community.

7. Method Email/Online survey 6 week period
Both Dietitian covering ITU/Consultant Intensivist response.
Based around previous survey questions
Data via Numbers / Excel

8. Respondents
All 16 units responded
12 Dietitians
12 Intensivists

9. Results

10. Nutritional Review

11. Dietitian WTE
Optimal
Minimum

12. Calculation of requirements

15. Nasogastric Feeding

16. 91% of units routinely use NJ feeding
Post Pyloric Feeding
91% of units routinely use NJ feeding

17. Main barriers to placement: Availability of qualified staff and slots on endoscopy lists

18. Gastric Residual Volumes

19. Parenteral Nutrition

21. Training

22. Summary Positives Areas for development Early Enteral feeding
Poor calculation and communication of nutritional deficits
Appropriate use of post pyloric feeding
Increasing availability of NJ placement
Well developed teaching programs
Attendance/involvement in MDT and ward rounds
Majority have specialist critical care Dietitian
No units meet optimal dedicated Dietitian time

23. What is an ITU bed? Other AHP’s Intensivist Pharmacist Nurse Dietitian
Physiotherapist

24. Who’s at risk on your unit?
High Risk
Moderate Risk
Low Risk

25. Questions

26. Right Team, Right time, Right amount The A Team
Pharmacist
I love it when a Nutritional plan comes together!
Intensivist
Critical Care Nurse
Dietcian

27. Recommendations

28. References