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Congratulations to the Top 10 best performing sites from the INS 2013!

Place Site
1st Hospital General de Medellin, Luz Castro de Gutierrez, Medellin, Colombia and
Kingston General Hospital ICU Team, Kingston, Canada
3rd The Ministry of Health Ankara Numune Research and Training Hospital, ICU, Ankara, Turkey
4th University Hospital of Wales General ICU, Cardiff, Great Britain and
St Vincent's Hospital ICU, Melbourne, Australia
6th Trillium Health Partners, Mississauga Hospital ICU, Mississauga, Canada
7th Beaumont Hospital, Richmond ITU, Dublin, Ireland and
Logan Hospital ICU, Brisbane, Australia and
The Alfred ICU, Melbourne, Australia
10th Trillium Health Partners, Credit Valley Hospital ICU, Mississauga, Canada

Top performing sites from Colombia and Canada get attention from local press!

CNW 2014  BOB 2

The Best of the Best winners at Clinical Nutrition Week 2014 in Savannah, Georgia

 CNW 2014 BOB Columbia

 Hospital General de Medellin accepting their 1st place BOB award at CNW. 

"Our hospital is a university that is highly committed to quality care for our patients, this includes nutritional support in both ICU and hospital level, which has given us many tools that have facilitated addressing the current demands of nutritional support in the critically ill patient. As an example we have a strict nutritional support admission protocol that supports feeding within the first 24-48 hours of ICU admission. This protocol is based on the best available evidence, is known by all the team of the ICU and provides basic information on the choice of the route of feeding, formula given by type of patient and the strategies used to manage possible intolerance related to nutritional support such as drug use or early prokinetic effect using small bowel feeding tubes. This favors the nutritional intake, that goals are maintained and that these goals are achieved in short periods of time, always prioritizing the enteral route when available and limiting parenteral nutrition. Also we have a checklist that patient safety is applied 2 times daily check where the patient has nutritional support and is tolerating it. We have the ability to have a full-time dietitian on the unit who is present during the medical rounds allowing direct and constant communication with the doctor. Our nursing staff is instrumental to the implementation of these guidelines and to support each others' continuing education processes and the proper recording of the achieved nutritional intake as well as the various events that occur during patient care that can become barriers to achieving the goals. The participation of the "UCI-A" in INS 2011 allowed us to target our weaknesses and recommendations generated afterwards impacted positively on the implementation of strategies to improve the quality of nutritional support in our center making it more efficient and timely. Currently, we are working on strategies to decrease fasting time in patients prior to various procedures."




Kingston General Hospital staff accepting their award from Dr. Heyland and Rupinder Dhaliwal

 CNW 2014 BOB Turkey

The Ministry of Health Anakara Numune Research and Training Hospital (Turkey) accepting their award

"We are very thankful to Dr. Daren Hayland and Mr.Mehmet Uyar who is the president of the Turkish Nutrition Association to encourage us for taking part in this survey. We are very proud of having this prize. This is a great accomplishment as we have placed third in the Best of Best in 2013 International Nutrition Survey. Our success can be attributed to a number of factors. First of all, there is a real sense of teamwork in our clinic and this team has a true awareness about the importance of nutrition in patient care. Secondly, we have a nutrition order that assesses each patient in the ICU upon admission so that nutrition automatically starts whether or not a dietitian is present. This allows nutrition support to begin shortly after patient admission. Then the dietitian follows up making any necessary adjustment. Also in our clinic, nutrition support therapy is guided by evidence-based guidelines encompassing international nutrition support guidelines. Continued education and team meetings within the clinic ensure that ICU staff are kept informed about importance of nutrition support in patient treatment." - Dr. Hatice Yagmurdur and his team in Turkey

 Wales ICU

The University Hospital of Wales General ICU

"The Critical Care Unit at the University Hospital of Wales were extremely pleased to be ranked joint 4th in the 2013 Critical Care Nutrition Quality Improvement Project. We believe our success is a combination of initiatives which include:
• Development of a positive culture amongst the medical and nursing staff with regards to the provision of nutrition and support to attend national and international conferences
• Comprehensive nutritional support guidelines are an integral part of ICU care. These are updated and reviewed on a regular basis in line with national and international guidelines and are evidence based and practice based
• Patients are fed as soon as clinically stable according to a weight based calculation and advanced according to tolerance
• Regular education and training of medical and nursing staff on all aspects of nutrition
• Participation at clinical meetings and daily ward rounds which enables effective communication, collaboration and bedside education of staff
• Regular audit cycles of the efficacy of the protocols in meeting the needs of our patient's nutritional requirements and of the adherence to the protocols.
This international survey has validated our internal audits and clinical practice. It has highlighted areas for improvement which we will be working on, with the aim of participating in the next international project and hopefully improving our position."

 St Vincents
St. VIncent's Hospital ICU
“Our success is attributed to the whole ICU team. We have a feeding algorithym so feeds are commenced any hour of the day and rate increased to target following clear guidelines. Our nurses play a vital role in initiating feeding and reducing interruptions. Nutrition is now on the Doctors checklist for their AM and PM ward rounds which encourages them to check if feeds have been commenced and nurses to report if feeds are at target rate. The ICU Dietitian has provided competency based training for all Dietitians covering ICU so that optimal nutrition care can be maintained. Participation in nutrition trials and regular nutrition in-services from the Dietitian has helped keep motivation and enthusiasm levels high to strive for ongoing success.” 

CNW 2014 BOB Trillium Miss

Trillium Health Partners Mississauga Hospital accepting their award from Dr. Heyland at CNW 

Trillium Health Partners, Mississauga Hospital's ICU is again ranked amongst the “Best of the Best” in the provision of Nutrition to Critically Ill Patients. In addition to the present 6th place ranking, we have placed in the top 10 in the 2008, 2009 and 2011 International Nutrition Surveys. We are proud that we have been able to sustain our high ranking and our results have shown a continued improvement. Our success can be attributed to many factors. The cohesive teamwork in the ICU fosters a culture, where the importance of nutrition is innate. Collaboration and communication are key components to success and Nutrition education is embedded in our Nursing Skills days and the Critical Care Nursing Students' curriculum. Another key factor has been our continued participation in the International Nutrition Surveys. We feel fortunate that we have this opportunity as the results and reports provide us with very valuable information. From our site reports, we have been able to identify areas for improvement and have seen the results of the changes we have implemented. Through the development and revision of our Admission and Procedural Order sets, we ensure nutrition gets implemented promptly and the amount of time without nutrition is minimized. The importance of the Dietitians role in ensuring optimal nutrition, as identified in the Nutrition surveys, has enabled us to advocate and obtain an FTE enhancement. We will again, use the information from the survey and our site report to identify further areas for improvement, which in turn will ensure our patients receive optimal nutrition and optimal care. 

Beaumont Hospital RIchmond ITU (no photo available): Richmond ITU and General ITU in Beaumont Hospital, Dublin have taken part in the INS since 2007. The presence of a Clinical Specialist dietitian working in critical care in Beaumont Hospital in conjunction with the ICU Director and consultant Intensivists has established and defined the high standards of nutritional care in our ITUs. Richmond ITU has 0.5 dedicated dietitian time to its 10 beds. Nutrition support practices are guided by evidence based guidelines encompassing international nutrition support guidelines such as Canadian Clinical Practice Guidelines, ESPEN, NICE and ASPEN guidelines, as well as Irish guidelines (Nutrition Support Interest Group: Nutrition Support Reference Guide - for dietitians). Richmond ITU takes part in the INS as a quality assurance measure and benchmarking opportunity. Each audit has highlighted the strengths and weaknesses of our ICUs which have led to improvements in our clinical practice. The development of National Nutrition Support in Critical Care algorithms and a supporting reference document, and the presence of our local nutrition support guidelines means that early feeding can be commenced ‘out-of-hours' without the presence of a dietitian. The protocol proves a useful tool for ICU staff as it provides information on the choice of feeding route, appropriate feed and strategies to manage feed intolerance. Nursing staff are pivotal in the practical application of these guidelines. Another initiative which has helped to maximise enteral feeding of patients, is the placement of NJ tubes, which has been made easier in our ICU with the use of the Cortrak enteral access system, This allows for NJ tube placement at the bedside. Open communication within the ICUs, regular multidisciplinary team meetings, regular updates provided by ICU dietitians, and ongoing CPD in the area of feeding the critically ill patient, ensure that ICU staff are kept informed and updated regarding nutritional developments and best practice.  

 Logan photo

Logan Hospital ICU, Brisbane, Australia

"A key driver of successful nutrition delivery in the Logan ICU is a nurse led algorithm that empowers nurses to select the feed type and rate, thereby promoting its acceptance. This enables early initiation of feeding without the need for the ICU consultant or dietitian to be present. As a result, the nursing staff are highly motivated in promoting the early initiation of nutrition with medical staff over the entire 24 hours. The algorithm also includes decision making regarding mode of feeding, and processes to deal with feeding intolerance. The algorithm was originally designed by the dietitian, with adjustments made based on feedback from nursing and medical staff. Adjustments are also made to the algorithm to adapt processes in accordance with changing evidence based guidelines. The leadership from the Nurse Unit Manager and the Director of ICU in recognising the importance of nutrition and supporting the role of the dietitian as part of the ICU team are key aspects of assisting with adherence to nutritional guidelines. Involvement in nutrition research (in individual trials and the International Nutrition Survey) has been a great motivator to improving nutritional delivery and promoting evidence based practice."

 CNW 2014 BOB Trillium Credit

 Trillium Health Partners Credit Valley Hospital accepting their BOB award at CNW


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