Following CUSP training, ICU experts address malnutrition prevention

For patients in the ICU who waver between life and death, adhering to necessary — and rigorous — medical treatment plans is a priority. But occasionally, between the frequent movements and different procedures, other markers of recovery can fall behind — like nutrition.

After completing the Comprehensive Unit-based Safety Program (CUSP), a method that trains health care teams to improve their clinical best practices and identify areas for improvement, UF Health Shands Hospital ICU experts, dieticians and nursing staff identified malnutrition as a priority for quality improvement initiatives.

“Due to illness and a variety of moving parts, some patients were not meeting their nutritional goals for the day,” said Dr. Philip A. Efron, M.D., professor of surgery and medical director for the UF Health Shands Hospital Surgical Intensive Care Units (SICUs). “We not only wanted to bring awareness to this, but also to improve it.”

Efron and Four East unit staff, a wing of UF Health that cares for liver transplant patients and other surgical patients, established a baseline of the appropriate nutritional goals for patients and to what extent they were being met.

In some cases, staff noted that they were underutilizing total parenteral nutrition, or TPN, when it was necessary. This lack of nutrition can be associated with many poor outcomes, including, but not limited to complications like increased infections, poor wound healing, and other outcomes that someone in the ICU could particularly suffer from.

Although standard and enteral nutrition are often preferable, ICU patients who require feeding via TPN, receive nutrients intravenously. And, for those who are struggling to recover from traumatic injuries or severe illness, ensuring appropriate nutrition takes place is a key foundation for the weeks and months it can take the body to heal.

Currently, the focus is on maintaining the process improvements the team implemented, Efron said. He credits the CUSP process for empowering each member of the staff to commit to the changes — now, and in the future. The initiative’s success can be attributed to the work of many UF Health and 4East staff members, including Kristen Drake (dietician), Charles Cresconi (Quality), Mariah Southerland (4East RN CUSP), Noel Walker (4East), Patricia Walker (ARNP CMM), Jeremy Gordon (CCM), Gabby Cousin (Organ TRN Manager), Lilliana Bell, (Quality), Jennifer LaLonde (4East Manager), Abbas Shahmohammadi, M.D. (Transplant Critical Care Director), and many more.

“If you are serious about doing quality improvement, the sort of processes and metrics that are required to do something sustainably are going to be time-consuming,” Efron explained. “It will be exciting for six months, but after that many quality improvement initiatives fall off the wagon, so to speak.”

The difference?

“We’re lucky to have a team that understands the importance, and cares to see it through,” Efron said. “Our staff, for example, have accepted this as a new part of our processes that is here to stay. And they do that because they care about our patients.”