PERFormance Enhancement of the Canadian Nutrition Guidelines by a Tailored Implementation Strategy: The PERFECTIS Study

NCT01168128 | Completed

• 1 other identifier: PERFECTIS
• Study Type: interventional
• Target: 278
• Locations: 2 countries
• Sites: 5

Brief Summary

Canadian Critical Care Nutrition Guidelines assist health practitioners in identifying best practices for feeding critically ill patients. However, guidelines have resulted in little change in Intensive Care Unit (ICU) practices, possibly because barriers to change differ between ICUs. Change may be facilitated if strategies specifically address identified barriers. The investigators hypothesize that barriers are inversely related to nutrition performance. Tailoring change strategies to overcome barriers to change will reduce the presence of these barriers and lead to improvements in nutrition practice.

Conditions

Critically Ill; Intensive Care Unit

Keywords

Enteral Nutrition; Parenteral Nutrition; Critically ill; Nutrition Therapy; Nutrition Support; Practice Guidelines as Topic; Guideline Adherence; Quality Assurance, Health Care; Nutrition Surveys; Questionnaires

Outcome Measures

Primary Outcomes (1)

• Feasibility of the study design and intervention

  Assessed by rate of completion of barriers questionnaires, development of unique tailored action plans at each site, compliance and satisfaction with the tailored action plans, and other user feedback.

  12 months post implementation of intervention

Secondary Outcomes (2)

• Change in nutrition performance score

  20-24 months

• Change in barriers to implementation of critical care nutrition clinical practice guidelines

  12 months post implementation of intervention

Study Arms (1)

Tailored Action Plan

EXPERIMENTAL

A Tailored Action Plan is an intervention selected to overcome barriers identified before the design and delivery of the intervention.

Other: Tailored Change Strategy

Interventions

Tailored Change Strategy OTHER

e.g. Education, decision support tools

Tailored Action Plan

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• ICUs must be affiliated with a registered dietitian.
• ICUs must have a minimum of 8 beds.
• ICUs must be located in Canada, Australia, or US.
• ICUs have previously participated in the International Nutrition Survey.

You may not qualify if:

• ICUs with less than 8 beds.
• ICUs with high nutrition performance, as demonstrated previously in the International Nutrition Survey (i.e. average nutritional adequacy \>60% and/or above 50th percentile when ranked against all participating ICUs according to nutrition practice performance score)

Sponsors & Collaborators

• Daren K. Heyland: lead
• Ministry of Research, Innovation and Science, Ontario: collaborator
• Canadian Foundation for Dietetic Research (CFDR): collaborator

Study Sites (5)

Anne Arundel Medical Center

Annapolis, Maryland, United States

Location

Spartanburg Regional Medical Center

Spartanburg, South Carolina, United States

Location

Peter Lougheed

Calgary, Alberta, Canada

Location

Capital Health - University of Alberta Hospital (hospital general systems)

Edmonton, Alberta, Canada

Location

Southlake Regional Health Centre

Newmarket, Ontario, Canada

Location

Related Publications (6)

• Jones NE, Dhaliwal R, Day AG, Ouellette-Kuntz H, Heyland DK. Factors predicting adherence to the Canadian Clinical Practice Guidelines for nutrition support in mechanically ventilated, critically ill adult patients. J Crit Care. 2008 Sep;23(3):301-7. doi: 10.1016/j.jcrc.2007.08.004. Epub 2007 Dec 11.

  PMID: 18725033 BACKGROUND

• Jones NE, Suurdt J, Ouelette-Kuntz H, Heyland DK. Implementation of the Canadian Clinical Practice Guidelines for Nutrition Support: a multiple case study of barriers and enablers. Nutr Clin Pract. 2007 Aug;22(4):449-57. doi: 10.1177/0115426507022004449.

  PMID: 17644700 BACKGROUND

• Cahill NE, Heyland DK. Bridging the guideline-practice gap in critical care nutrition: a review of guideline implementation studies. JPEN J Parenter Enteral Nutr. 2010 Nov-Dec;34(6):653-9. doi: 10.1177/0148607110361907.

  PMID: 21097765 BACKGROUND

• Cahill NE, Suurdt J, Ouellette-Kuntz H, Heyland DK. Understanding adherence to guidelines in the intensive care unit: development of a comprehensive framework. JPEN J Parenter Enteral Nutr. 2010 Nov-Dec;34(6):616-24. doi: 10.1177/0148607110361904.

  PMID: 21097762 BACKGROUND

• Cahill NE, Murch L, Cook D, Heyland DK; Canadian Critical Care Trials Group. Implementing a multifaceted tailored intervention to improve nutrition adequacy in critically ill patients: results of a multicenter feasibility study. Crit Care. 2014 May 11;18(3):R96. doi: 10.1186/cc13867.

  PMID: 24887445 DERIVED

• Cahill NE, Murch L, Cook D, Heyland DK; Canadian Critical Care Trials Group. Barriers to feeding critically ill patients: a multicenter survey of critical care nurses. J Crit Care. 2012 Dec;27(6):727-34. doi: 10.1016/j.jcrc.2012.07.006. Epub 2012 Sep 13.

  PMID: 22981532 DERIVED

Related Links

• Clinical Evaluation Research Unit's Critical Care Nutrition website

MeSH Terms

Conditions

Critical Illness; Hyperphagia

Condition Hierarchy (Ancestors)

Disease Attributes; Pathologic Processes; Pathological Conditions, Signs and Symptoms; Signs and Symptoms, Digestive; Signs and Symptoms

Study Officials

• Daren K Heyland, MD

  Clinical Evaluation Research Unit

  PRINCIPAL INVESTIGATOR

• Heather Stuart, PhD

  Queen's University

  PRINCIPAL INVESTIGATOR

• Naomi E Cahill, RD, MSc

  Queen's University, Clinical Evaluation Research Unit

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: NA
• Masking: NONE
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: SINGLE GROUP
• Sponsor Type: OTHER
• Responsible Party: SPONSOR INVESTIGATOR
• PI Title: Director of Clinical Evaluation Research Unit

Study Record Dates

• First Submitted: July 21, 2010
• First Posted: July 23, 2010
• Study Start: September 16, 2009
• Primary Completion: September 1, 2011
• Study Completion: September 1, 2011
• Last Updated: December 17, 2020

Record last verified: 2020-12

Locations

US (2); CA (3)