Improving the Administration of Protein Supplements in the Medical Intensive Care Unit

Abstract

Problem: An academic medical center reported that only 37% of inpatients in the Medical Intensive Care Unit (MICU) receive the ordered amount of protein supplements as part of their enteral nutrition. This is not enough to meet the protein needs for these patients. An increase in a patient’s daily protein intake is associated with improved wound healing, reduced hospital length of stay, reduced infection complications, decreased mortality and improved long-term quality of life. The unit did not have a standardized protocol for protein supplement administration or documentation. Purpose: The purpose of this quality improvement (QI) project in the MICU is to increase the documentation of protein supplement administration through the implementation of a standardized process for protein supplement administration. Methods: As part of the project, a standardized schedule was created for protein supplement administration, which was provided to nursing staff. MICU nursing staff also received education regarding the importance of protein supplements and the importance of the required documentation following administration. Amount of protein supplement administration were collected via chart review, using the REDCap data collection tool. Results: 77 patients were included in the preimplementation audit and 318 patients were included in the post-implementation audit. When comparing the documented administration to the number of protein supplements that are ordered, the average administration rate for the MICU following the QI project implementation is 73.6%, which is higher than the pre-implementation rate of 37%. Conclusions: The findings of this QI project would suggest an increase in the rate of protein supplement administration and documentation through the use of a standardized schedule for administration and the education of bedside MICU nursing regarding the importance of protein supplements for adult critically ill patients.