Australian and New Zealand Cluster Randomised trial of Evidence-based Guidelines for Nutrition Support in Critical Illness
Cluster randomised trial evaluating the impact on mortality of evidence based guidelines for nutritional support in critical illness
Dr Gordon Doig
1,500 participants
Apr 1, 2003
Interventional
Conditions
Summary
Nutritional support is accepted as a standard of care for critically ill patients although there is little agreement as to how it is best provided. Use of evidence-based guidelines has been shown to improve the effectiveness of care. The purpose of this project is to develop, promote and evaluate evidence-based clinical practice guidelines for nutritional support in the ICU in twenty-six hospitals throughout Australia and New Zealand. One half of the hospitals will be randomised to receive educational sessions based on the content of the guidelines using previously proven and accepted educational strategies. A cluster randomised trial will then evaluate the impact of these educational sessions on acceptance of the guideline and on patient outcomes.
Eligibility
Inclusion Criteria1
- Adult patients expected to require ICU care for longer than 2 days.
Exclusion Criteria6
- Already tolerating an adequate oral diet;
- Scheduled to return to oral intake within 24 hours;
- Admitted to ICU for palliative care;
- Moribund and not expected to survive 6 hours;
- Brain dead or suspected to be brain dead;
- Admitted directly to the study ICU from any other ICU.
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Interventions
The study intervention involves the implementation of National-level guidelines for the provision of nutritional support in critical illness. 27 hospitals participated in this trial: 14 hospitals were randomised to the intervention group (guidelines implementation) and 13 were randomised to the control (standard care) group. The 14 intervention group hospitals received education on the content of the feeding guidelines and the 13 control hospitals received no education. Education was provided via a formal practice change strategy composed of Educational Outreach (one session, 45-60mins), Academic Detailing (as much as required), Posters, Active Reminders, Audit and Feedback and traditional in-servicing (as many sessions as required, 30-60mins per session).
Locations(1)
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ACTRN12608000407392