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Measure Summary
Title
Assessment of risk and prevention of malnutrition: percentage of intensive care unit (ICU) patients who are assessed for risk of malnutrition within 24 hours after admission.
Source(s)
Ministry of Health. Safe practices indicators project: background, summary of methods and measurement strategies. Madrid: Ministry of Health; 2009 Feb 20. 97 p.

Measure Domain

Primary Measure Domain
Clinical Quality Measures: Process
Secondary Measure Domain
Does not apply to this measure

Brief Abstract

Description

This measure is used to determine the percentage of patients admitted to the intensive care unit (ICU) for at least two days who are assessed for the risk of malnutrition within 24 hours after admission. The explicit assessment may be based on specific indexes such as the Subjective Global Assessment (SGA) or the Screening Tool for the Nutritional Control (CONUT) scales, or on the following symptoms:

  • Cachexia
  • Weight loss in the last three months of greater than 10%
  • Serum albumin less than 30 gr/l
  • Artificial nutrition
  • Inadequate oral feeding during greater than 1 week
Rationale

Malnourished patients experience increased morbidity and mortality and prolonged hospital stays. Malnutrition in hospitalized patients is frequently not recognized. Providing nutritional support to patients who are either malnourished or at risk of malnutrition can result in improved clinical outcomes and fewer adverse events. Intensive care unit (ICU) patients are particularly at risk.

Main aim of indicator: to increase the percentage of ICU patients who are assessed for the risk of malnutrition in the first 24 hours after admission.

Evidence for Rationale
Ministry of Health. Safe practices indicators project: background, summary of methods and measurement strategies. Madrid: Ministry of Health; 2009 Feb 20. 97 p.
Primary Health Components

Malnutrition; assessment; intensive care unit (ICU)

Denominator Description

Number of patients admitted to intensive care unit (ICU) for more than 48 hours

Numerator Description

Number of patients assessed for risk of malnutrition within 24 hours after admission to intensive care unit (ICU) x 100 (see the related "Numerator Inclusions/Exclusions" field)

Evidence Supporting the Measure

Type of Evidence Supporting the Criterion of Quality for the Measure
  • A clinical practice guideline or other peer-reviewed synthesis of the clinical research evidence
  • A formal consensus procedure, involving experts in relevant clinical, methodological, public health and organizational sciences
  • A systematic review of the clinical research literature (e.g., Cochrane Review)
  • One or more research studies published in a National Library of Medicine (NLM) indexed, peer-reviewed journal
Additional Information Supporting Need for the Measure

Intensive care unit (ICU) patients are not routinely assessed for risk of malnutrition within 24 hours after admission.

Evidence for Additional Information Supporting Need for the Measure
Ministerio de Sanidad y Consumo. Indicadores de buenas practicas sobre seguridad del paciente. Resultados de su medicion en una muestra de hospitales del sistema nacional de salud Español. Madrid: Ministerio de Sanidad y Consumo; 2008. 95 p.
Extent of Measure Testing

After pilot testing, the set of indicators has been measured in a random sample of 25 Spanish hospitals, stratified by hospital size. The main objective has been to field test the feasibility of measurement in the various settings representing real life situations in the context of the Spanish Health Care System.

Both the whole indicators validation report and the results of the baseline measurement in a sample of the Spanish National Health Service (NHS) hospitals may be accessed and downloaded from the Spanish Ministry of Health web page (in Spanish):

Evidence for Extent of Measure Testing
Ministerio de Sanidad y Consumo. Construccion y validacion de indicadores de buenas practicas sobre seguridad del paciente. Madrid: Ministerio de Sanidad y Consumo; 2008. 178 p.

Ministerio de Sanidad y Consumo. Indicadores de buenas practicas sobre seguridad del paciente. Resultados de su medicion en una muestra de hospitales del sistema nacional de salud Español. Madrid: Ministerio de Sanidad y Consumo; 2008. 95 p.

Ministry of Health. Safe practices indicators project: background, summary of methods and measurement strategies. Madrid: Ministry of Health; 2009 Feb 20. 97 p.

State of Use of the Measure

State of Use
Current routine use
Current Use
Internal quality improvement

Application of the Measure in its Current Use

Measurement Setting
Hospital Inpatient
Intensive Care Units
Professionals Involved in Delivery of Health Services
Advanced Practice Nurses
Nurses
Physicians
Least Aggregated Level of Services Delivery Addressed
Single Health Care Delivery or Public Health Organizations
Statement of Acceptable Minimum Sample Size
Unspecified
Target Population Age

Unspecified

Target Population Gender
Either male or female

National Strategy for Quality Improvement in Health Care

National Quality Strategy Aim
Better Care
National Quality Strategy Priority
Making Care Safer
Prevention and Treatment of Leading Causes of Mortality

Institute of Medicine (IOM) National Health Care Quality Report Categories

IOM Care Need
Getting Better
Living with Illness
IOM Domain
Effectiveness
Safety

Data Collection for the Measure

Case Finding Period

Unspecified

Denominator Sampling Frame
Patients associated with provider
Denominator (Index) Event or Characteristic
Institutionalization
Denominator Time Window
Does not apply to this measure
Denominator Inclusions/Exclusions

Inclusions
Number of patients admitted to intensive care unit (ICU) for more than 48 hours

Exclusions
None

Exclusions/Exceptions
Unspecified
Numerator Inclusions/Exclusions

Inclusions

Number of patients assessed* for risk of malnutrition within 24 hours after admission to intensive care unit (ICU) x 100

*The explicit assessment may be based on specific indexes such as the Subjective Global Assessment (SGA) or Screening Tool for the Nutritional Control (CONUT) scales, or on the following symptoms:

  • Cachexia
  • Weight loss in the last three months of greater than 10%
  • Serum albumin less than 30 gr/l
  • Artificial nutrition
  • Inadequate oral feeding during greater than 1 week

Exclusions
None

Numerator Search Strategy
Fixed time period or point in time
Data Source
Administrative clinical data
Paper medical record
Type of Health State
Does not apply to this measure
Instruments Used and/or Associated with the Measure
  • Subjective Global Assessment (SGA)
  • Screening Tool for the Nutritional Control (CONUT)

Computation of the Measure

Measure Specifies Disaggregation
Does not apply to this measure
Scoring
Rate/Proportion
Interpretation of Score
Desired value is a higher score
Allowance for Patient or Population Factors
Unspecified
Standard of Comparison
Internal time comparison

Identifying Information

Original Title

Percentage of intensive care unit (ICU) patients who are assessed for risk of malnutrition within 24 hours after admission.

Measure Collection Name
Submitter
Spanish Agency for Healthcare Quality of the Spanish Ministry of Health - National Government Agency [Non-U.S.]
Developer
Grupo de Investigación sobre Gestión de la Calidad en Servicios de Salud, University of Murcia, under contract to the Spanish Ministry of Health - National Government Agency [Non-U.S.]
Funding Source(s)

Agency for Quality, Spanish Ministry of Health

Composition of the Group that Developed the Measure

Saturno, Pedro J., MD, DrPH; Group Director and Project PI

Castillo, Carmen; López, M. José; Ramón, Teresa; Nurses

Carrillo, Andrés, MD; Intensive Care Specialist

Iranzo, M. Dolores; Hospital pharmacist

Soria, Victor, MD; Surgeon

Parra, Pedro, MD; Gomis, Rafael, MD; Gascón, Juan J., MD; Quality Management Specialists

Financial Disclosures/Other Potential Conflicts of Interest

Project entirely financed by the Spanish Ministry of Health.

Adaptation

This measure was not adapted from another source.

Date of Most Current Version in NQMC
2009 Feb
Measure Maintenance

Unspecified

Date of Next Anticipated Revision

Unspecified

Measure Status

This is the current release of the measure.

The measure developer reaffirmed the currency of this measure in May 2014.

Source(s)
Ministry of Health. Safe practices indicators project: background, summary of methods and measurement strategies. Madrid: Ministry of Health; 2009 Feb 20. 97 p.
Measure Availability

The individual measure, "Percentage of Intensive Care Unit (ICU) Patients Who are Assessed for Risk of Malnutrition Within 24 Hours After Admission," is published in "Safe Practices Indicators Project: Background, Summary of Methods and Measurement Strategies."

For more information, contact:

  • Ministry of Health and Social Policy, Paseo del Prado, 18-20, planta baja, esquina con Lope de Vega. 28014 Madrid; Phone: +34 901 400 100; Fax: +34 915 96 44 80; Web site: www.msc.es/en/home.htm External Web Site Policy.

    OR

  • Pedro J. Saturno, Facultad de Medicina, Universidad de Murcia, 30100 Espinardo-Murcia (Spain); Phone: 868 883 948; Fax: +34 868 883947; E-mail: psaturno@um.es; Web site: http://www.calidadsalud.com External Web Site Policy.
Companion Documents

The following are available:

  • Ministerio de Sanidad y Consumo. Construccion y validacion de indicadores de buenas practicas sobre seguridad del paciente. Madrid: Ministerio de Sanidad y Consumo; 2008. 178 p. This document is available in Portable Document Format (PDF) from the Ministry of Health and Social Policy Web site External Web Site Policy (in Spanish).
  • Ministerio de Sanidad y Consumo. Indicadores de buenas practicas sobre seguridad del paciente. Resultados de su medicion en una muestra de hospitales del sistema nacional de salud Español. Madrid: Ministerio de Sanidad y Consumo; 2008. 95 p. This document is available in PDF from the Ministry of Health and Social Policy Web site External Web Site Policy (in Spanish).
NQMC Status

This NQMC summary was completed by ECRI Institute on September 11, 2009. The information was verified by the measure developer on December 23, 2009.

This NQMC summary was retrofitted into the new template on July 27, 2011.

The information was reaffirmed by the measure developer on May 13, 2014.

Copyright Statement

No copyright restrictions apply.

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