Acknowledgements

1. Improved Glycemic Control and Early Enteral Feeding In Mechanically Ventilated PatientsDenise Baird Schwartz, MS, RD, FADA, CNSD, Nutrition Support CoordinatorProvidence Saint Joseph Medical Center, Burbank, California, USA Acknowledgements Barry Wolfman; Mayur Patel, MD; William Scott, MD; Carol Granados, MS, RD, CDE; Robert Pickett, RN, MSN; Maggie Ongkiko, RN, MSN; Teresa Lee-Yu, PharmD; Sonja Draganic; Brenda Clemens, RN, BHA, CPHQ; Lisa Blomley, RN, CDE; Madeline Vallejo, RN, CDE; Rosemarie Boward, PharmD; Lisa Barile, RN, CCRN, PCCN; Kathe Rich, RN; Carol Kennedy, MT (ASCP); Frank Espino, RCPT; Matthew Sandoval, MHA; Naomi Cahill, RD, MSC • Our Mission and Core Values • include a focus on the vulnerable through compassionate service, with an • emphasis on excellence and stewardship. Critically ill patients on • ventilators have limited ability to communicate with their healthcare • providers and loved ones. It is with the greatest respect for these • vulnerable individuals we strive for best practice and to use our • resources wisely. With these studies we observed reductions in mortality: 27% observed/expected mortality with improved glycemic control in study group (0.82) compared to all patients in ICU Nov 2008-Feb 2009 (1.12) 27% observed/expected mortality with time to start enteral feeding in study group (0.93) compared to all patients in May-June 2010 (1.28) 6-11% ICU risk adjusted mortality during two follow-up study periods Nov 2008-Feb 2009 and May-June 2010 • Introduction • We designed an action plan using external benchmarks for best practice to set goals, and showed improvement in glycemic control and early enteral feeding in ventilator dependent patient care. These improvements occurred with a multidisciplinary effort through dissemination of information, education, and auditing to determine goals achieved. Figure 1. Glycemic Control Figure 2. Time to Start Enteral Feeding Methods We provided 20 patient’s data of the 2946 in an international nutrition study 2007, that included 158 facilities from 20 countries. After implementing practice changes in 2 ICUs (38 beds), glycemic control (Nov 2008-Feb 2009) and enteral feeding start time (May-June 2010) were re-measured (20 each group). Critically ill adult (aged >18 years) patients who were mechanically ventilated within the first 48 hours of direct ICU admit and remained on the ventilator >72 hours were enrolled. Data were collected on parameters identified for improvement and characteristics of the patient groups, including: age, gender, APACHE II score, route of alimentation, ventilator days, ICU length of stay, hospital length of stay, and outcome. Conclusions We conducted an improving organizational performance project dealing with areas identified in an international nutrition study 2007. By focusing on glycemic control and early enteral feeding, goals to improve actual practice were achieved with a trend towards mortality reduction. In conclusion, using external benchmarks provides an opportunity to set goals based on real, achievable levels of performance and improve patient care. Results Re-measured data were compared with our 20 patients in the international nutrition study 2007. Figure 1 shows results of the glycemic control study: 10% from 142 mg/dL compared to 128 mg/dL (P=0.001). Figure 2 shows results of the time to start enteral feeding study: 59% from 68 hours compared to 28 hours (P =0.071).