PERFormance Enhancement of the Canadian Nutrition Guidelines by a Tailored Implementation Strategy: The PERFECTIS Study
NCT ID: NCT01168128
Last Updated: 2020-12-17
Study Results
The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.
Basic Information
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COMPLETED
NA
278 participants
INTERVENTIONAL
2009-09-16
2011-09-30
Brief Summary
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Detailed Description
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1. Audit of Nutrition Practices: The nutrition practice audit will be conducted as part of the data collection for our ongoing international nutrition quality improvement project. This involves collecting data on personal characteristics and nutrition therapy in a consecutive cohort of 20 mechanically-ventilated critically ill adult patients. Performance at each ICU will be assessed by a benchmarked report comparing the nutrition practices to individual recommendations of the Canadian Critical Care Nutrition CPGs, thus enabling identification of the ICUs strengths and weaknesses, and highlighting areas to target for improvement.
2. Barriers Questionnaire: The barriers and enablers questionnaire will be completed by all physicians, all ICU leadership, the dietitian(s), and a random sample of 30 full- and part-time nurses. This questionnaire asks questions about barriers associated with guideline implementation, such as the characteristics of the guidelines, the care provider, the patient, and the context.
3. Tailored Action Plan: Results of the audit of nutrition practices and barriers questionnaire will be evaluated by the investigators and representatives from the Canadian Critical Care Nutrition CPGs Committee. Committee members include research personnel, intensivists, ICU nurse educators, dietitians, and experts in knowledge translation and health services research. They will be responsible for reviewing the benchmarked reports for each participating ICU, identifying the gaps between the key guideline recommendations and what is actually happening in practice, and reviewing the results of the barriers questionnaire to identify the barriers associated with adhering to these specific recommendations at each site. In collaboration with the local opinion leaders, a tailored 12 month action plan will be developed for each individual ICU.
The specific behavioral change strategies to be implemented as part of the tailored action plan will likely include powerpoint presentations and handouts, packages of key journal articles, reminders (e.g. posters, checklists), system tools (e.g. pre-printed orders, bedside algorithms), interactive web-based tutorials, guidelines on establishing local implementation teams and creating a culture of team work. Prior to the implementation of these behavioral change strategies in the context of the before-after study, focus groups will be conducted to elicit feedback, and revisions made accordingly.
4. Audit of Nutrition Practices: The audit of nutrition practices will be repeated following the 12 month implementation period in order to evaluate changes in nutrition practices.
Conditions
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Study Design
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NA
SINGLE_GROUP
HEALTH_SERVICES_RESEARCH
NONE
Study Groups
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Tailored Action Plan
A Tailored Action Plan is an intervention selected to overcome barriers identified before the design and delivery of the intervention.
Tailored Change Strategy
e.g. Education, decision support tools
Interventions
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Tailored Change Strategy
e.g. Education, decision support tools
Eligibility Criteria
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Inclusion Criteria
* 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.
Exclusion Criteria
* 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)
18 Years
ALL
No
Sponsors
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Ministry of Research, Innovation and Science, Ontario
OTHER
Canadian Foundation for Dietetic Research (CFDR)
OTHER
Daren K. Heyland
OTHER
Responsible Party
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Daren K. Heyland
Director of Clinical Evaluation Research Unit
Principal Investigators
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Daren K Heyland, MD
Role: PRINCIPAL_INVESTIGATOR
Clinical Evaluation Research Unit
Heather Stuart, PhD
Role: PRINCIPAL_INVESTIGATOR
Queen's University
Naomi E Cahill, RD, MSc
Role: PRINCIPAL_INVESTIGATOR
Queen's University, Clinical Evaluation Research Unit
Locations
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Anne Arundel Medical Center
Annapolis, Maryland, United States
Spartanburg Regional Medical Center
Spartanburg, South Carolina, United States
Peter Lougheed
Calgary, Alberta, Canada
Capital Health - University of Alberta Hospital (hospital general systems)
Edmonton, Alberta, Canada
Southlake Regional Health Centre
Newmarket, Ontario, Canada
Countries
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References
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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.
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.
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.
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.
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.
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.
Related Links
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Clinical Evaluation Research Unit's Critical Care Nutrition website
Other Identifiers
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PERFECTIS
Identifier Type: -
Identifier Source: org_study_id
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