QI Tools

The resource center is a web-based toolkit intended to be used by critical care practitioners (e.g. dietitians, physicians, nurses, pharmacists) engaged in providing nutrition therapy to critically ill patients for quality improvement (QI) purposes.  The resource centre can be used to support the implementation of critical care nutrition guidelines or for self-development (i.e. to learn more about different aspect of nutrition therapy).

Browse tools by Resource Type: 

• Bedside Materials
• Information Documents
• Multimedia
• Training Materials

Bedside Tools

PEP uP Excel Daily Checklist

Creator: Naomi Cahill and Lauren Murch
Date: December 2010
Synopsis: An excel spreadsheet used to monitor the progress of enteral nutrition.  Automatically generates a graphical visual of the adequacy of nutrition delivered.

Adjusting Goal Feed Rates for Propofol

Creator: Jan Greenwood
Date: Summer 2010
Synopsis: This Bedside Tool outlines how and when to adjust feed rates to account for propofol in order to avoid overfeeding.

Nutrichu and Nutrichu User Guide

Creator: Jean-Charles Preiser
Date: Spring 2011
Synopsis: The purpose of the "NutriChu" software is to improve the nutritional therapy by adapting the prescription to the actual status of critically ill patients staying in intensive care units. "NutriChu" enables the calculation of the actual caloric and protein intakes, and the comparison with recommended targets (goals). The results are calculated automatically and displayed graphically. This software is the result of a close multi-disciplinary collaboration of different departments at the University Hospital of Liege (Belgium), and involved physicians; nurses, dieticians, pharmacists cooperating with Nutritional Team of the hospital.

Care and Management of Nasoduodenal Feeding Tubes

Creator: Jan Greenwood
Date: 01/04/2010
Synopsis: This Bedside Tool includes information on securing nasoduodenal tubes, initiating and titrating feeds, prevention of aspiration, and other troublshooting tips related to post-pyloric feeding.

Daily EN Checklist

Synopsis: This checklist for monitoring of EN helps determine if EN goals (to safely deliver >80% of calories daily) are being met, and if not, if appropriate startegies are being adopted (motility agents, small bowel feeds, etc) to achieve the highest possible EN adequacy.

EN Guideline for Surgical Procedures

Creator: Developed by: Dr Michael Meier, Adapted by: Dr John Drover
Date: Summer 2010
Synopsis: This guideline is meant to assist with the management of enteral feeding in critically ill patients that are going the operating room for a procedure. It outlines when to stop feeds prior to transfer to the operating room, and when/how to restart feeds upon the patient's return to the ICU.

Gastric Feeding Algorithm

Creator: Jan Greenwood
Date: 01/04/2010
Synopsis: This Bedside Tool is a visual step-by-step guide to gastric feeding and managing high gastric residual volumes in the critically ill, where the goal is to safely deliver >80% of calories daily.

Glycemic Control Protocol

Creator: KGH
Synopsis: This glycemic control protocol outlines frequency of monitoring blood glucose under various conditions, dosing and infusion rates for initiation of insulin therapy (when blood glucose is >9mmol/L) and dosing and infusion rates for continuation of insulin therapy.

Head of Bed Elevation Sticker

Date: 2009
Synopsis: These stickers are intended to be printed and placed on the patients feeding bag as a reminder to bed-side staff to elevate the head of the bed. The Head of Bed word or pdf files can be printed directly onto Avery 3-1/3"" x 4"" labels (compatible product codes are 5164, 5264, 5524, 8164, 8254, 8464, 48464, 55164, 58164, 48264).

ICU Guideline: Managing the Refeeding Syndrome

Creator: Jan Greenwood
Date: 01/04/2010
Synopsis: This Bedside Tool defines refeeding syndrome and provides information on monitoring patients at risk for refeeding syndrome, and adjusting the initiation and titration of feeds in those patients.

Management of Diarrhea Algorithm

Creator: Jan Greenwood
Date: 01/04/2010
Synopsis: This algorithm is a visual step-by-step guide to management of diarrhea in the critically ill.

Nasal/Oral Duodenal Feeding Tube Placement

Creator: Jan Greenwood
Date: Summer 2010
Synopsis: This pocket guide gives step by step information on placing post-pyloric feeding tubes. Also includes information on indications/contraindications, supplies needed and problem solving tips.

Nutrition Assessment checklist

Creator: Jan Greenwood
Date: Summer 2010
Synopsis: The Nutrition Assessment Checklist is a Bedside Tool designed to help dietitians identify patients who are at nutritional risk, to determine and record a nutrition care plan, and to make progress notes.

Parenteral Nutrition Algorithm

Creator: Jan Greenwood
Date: 01/04/2010
Synopsis: This algorithm is a visual step-by-step guide to use of PN in the critically ill.

PN Preprinted Orders

Creator: KGH
Synopsis: This is a pre-printed order for provision of parenteral nutrition. It also includes guidelines for calculation of energy requirements.

QI Assessment Form

Creator: Jan Greenwood
Date: 01/04/2010
Synopsis: This bedside quality improvement tool is used to track nutrition prescribed, calories and protein received, as well as interruptions to delivery of enteral nutrition. Use one form per patient, with rows in the form representing days in ICU.

PEP uP Diarrhea Guideline

Creator: PEP uP Study Team
Date: December 2010
Synopsis: This reference sheet provides a guideline for potential causes of diarrhea and factors to consider in its management.. It was developed for use alongside the PEP uP Protocol.

Post-Pyloric Feeding Algorithm

Creator: Jan Greenwood
Date: Summer 2010
Synopsis: This Bedside Tool is a visual step-by-step guide to post-pyloric feeding in the critically ill. Includes information on initiation and advancement of post-pyloric feeds, and when post-pyloric feeding is and is not appropriate.

Rapid Resource 1: Feeding Facts

Creator: Jan Greenwood
Date: Summer 2010
Synopsis: This pocket guide provides quick information on initiation, maintenance and termination of enteral nutrition.

Rapid Resource 2: TPN

Creator: Jan Greenwood
Date: 01/04/2010
Synopsis: This pocket guide gives information on determining energy requirements, calculating PN prescription, identifying and managing GI and metabolic complications.

Information Documents

The Right Approach to Nutrition Care in ICU Pamphlet

Feeding Your Family Member in the ICU

Date: 08/02/2011
Synopsis: This document is targeted at patients' family members, and contains information about why nutrition therapy might be required, and types of nutrition therapy that may be provided. It suggests things family members can do to help with feeding their loved one, such as questions they should be prepared to answer (such as patient's height and usual weight, nutritional status) as well as some questions they should ask about their family member's nutrition in the ICU.

Routes of Nutrition Support Algorithm

Creator: Jan Greenwood
Date: 01/04/2010
Synopsis: This algorithm is a visual step-by-step guide to deciding what route of nutrition a patient should receive.

Clinical Practice Guidelines Brochure

Date: 2009
Synopsis: This 4-page brochure developed in collaboration with Nestle Canada highlights key clinical practice guideline recommendations.

Rapid Resource 3: Tube Tips

Creator: Jan Greenwood
Date: Summer 2010
Synopsis: This pocket guide provides quick information on choosing a feeding route, placement method and type of tube. Also includes information on securing tubes and clearing occluded tubes.

Multimedia

Critical Care Nutrition course from Dietitians of Canada

Training Materials

Clinical Practice Guidelines Poster

Date: 2009
Synopsis: This poster developed in collaboration with Nestle Canada highlights key clinical practice guideline recommendations.

Clinical Practice Guidelines Screensaver

Date: 2009
Synopsis: The screensaver consists of a slideshow highlighting some of the key clinical practice guidelines e.g. early EN, use of feeding protocols, head of bed elevation. This messages are intended to be uploaded on to computers to act as remiders to bed-side staff.

Interactive Workshop Assessment Handout

Synopsis: The Interactive Workshop Assessment Handout is a form that will enable you to collect feedback from your workshop, including what people learned and if/how they intend to change practices. Related tool: The Interactive Workshop Guide will help you plan and execute a workshop.

Interactive Workshop Guide

Synopsis: This is a step-by-step guide to conducting your own interactive workshop in your ICU, where the goal is to problem solve and identify strategies for improvement of nutrition practices. Related tool: The Interactive Workshop Assessment Handout will allow you to collect feedback from your workshop.

Pre-Printed Order

Date: 2009
Synopsis: This feeding protocol includes a pre-printed order and algorithm to guide the provision of enteral nutrition.