Instruction Manual - Critical Care Nutrition...Clinical Evaluation Research Unit Kingston General Hospital Angada 4, 76 Stuart Street Kingston ON Canada K7L 2V7 Tel: 613 549 6666 ext

Instruction Manual

International Nutrition Survey 2009

Table of Contents Table of Contents..............................................................................................................2 Introduction .......................................................................................................................3 Study Contacts..................................................................................................................5 Acronyms ..........................................................................................................................6 General Guidelines ...........................................................................................................6 Critical Care Nutrition Website ..........................................................................................8 Survey Login Page and Registration.................................................................................9 Welcome ‘Home’ Page....................................................................................................12 Patient Status Page ........................................................................................................14 Screening........................................................................................................................15 Patient Baseline Form.....................................................................................................17 APACHE II ......................................................................................................................20 Baseline Nutrition Assessment .......................................................................................23 Daily Nutrition Data .........................................................................................................25 Enteral Nutrition Data......................................................................................................27 Parenteral Nutrition Data.................................................................................................30 60-day Outcomes............................................................................................................32 Finalizing Data Entry .......................................................................................................34 Appendices .....................................................................................................................35

Instructions: INS09 Date: November 2, 2009

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Introduction International Nutrition Survey This project involves a period-prevalence survey of nutrition therapies in critically ill patients in intensive care units (ICUs) across the world. This survey is to be conducted on 16 September 2009 or the nearest date practically possible. Dietitians (or other healthcare practitioners) at the respective ICUs will collect data such as site characteristics, patient demographics, direct observational data (i.e. head of the bed elevation), baseline APACHE II variables, length of stay, duration of ventilation and mortality. In addition, nutrition practices such as route of nutrition, kilocalories and protein levels prescribed and received, interruptions, supplementation, blood sugars, insulin, etc will also be collected on a daily basis from ICU admission to ICU discharge, death, or for a maximum of 12 days (whichever comes first). It is projected that the results of this survey will identify differences, highlight strengths and weaknesses, and hopefully illuminate opportunities to improve nutrition practices in Canada and throughout the world. Benchmarked Site Report In lieu of remuneration for participating in this project, you will be provided with a benchmarked site report. This site report summarizes your site’s performance and will allow you to compare your nutrition practices to other ICUs within your own country or region (‘Sister Sites’) and all the ICUs in the database (‘All Sites’). You will also be able to compare your performance to the recommendations of the Canadian Critical Care Nutrition (CCN) Clinical Practice Guidelines (CPGs). Best of the Best 2009 Although the hard work and dedication of all ICUs who participate in the international nutrition survey is recognized, in 2009, the top ten sites that meet the award eligibility criteria will be awarded the ‘Best of the Best’ plaque. The top three sites will also be awarded $1000 towards travel and expenses to attend the American Society of Parenteral and Enteral Nutrition’s (ASPEN’s) Clinical Nutrition Week 2010, where their excellence in nutrition practice will be recognized at a session in which Dr Heyland personally presents the awardees with their plaques. To be considered for this award, participating ICUs must meet the following criteria:

1. Entered data on a minimum of 20 critically ill patients. 2. Must have a feeding protocol in place. 3. Completion of a baseline nutrition assessment (i.e. nutrition prescription). 4. No missing data or outstanding queries. 5. Prepared to permit CCN to source verify the entered data.

Instruction Manual The Instruction Manual functions as a resource for successful completion of electronic case report forms (eCRFs) for the International Nutrition Survey.


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The manual is formatted to provide written instruction for each CRF. A webshot of the actual web page will follow written instructions. eCRFs are the primary mode of data capture used in the International Nutrition Survey. The dietitian (or other healthcare practitioner) is expected to enter data online as soon as it becomes available. Paper CRFs and worksheet templates are available as tools to assist in capturing the required data elements prior to online data entry. Copies of these paper CRFs/worksheets can be downloaded from our website (www.criticalcarenutrition.com).

Please keep ALL worksheets/documents that you use until you receive your benchmarked performance report. This will provide you with an opportunity to check your site report with the raw data and ensure that it is accurate. Please check with your hospital for local requirements regarding storage of data collection forms as this may differ by hospital site.

In the event that additional clarification is required; please contact the Project Assistant (PA) or the Project Leader (PL).


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http://www.criticalcarenutrition.com/


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Study Contacts Principal Investigator

Dr Daren Heyland Clinical Evaluation Research Unit Kingston General Hospital Angada 4, 76 Stuart Street Kingston ON Canada K7L 2V7 Tel: 613 549 6666 ext. 3339 Fax: 613 548 2428 Email: [email protected]

Project Leader

Naomi Cahill Clinical Evaluation Research Unit Kingston General Hospital Angada 4, 76 Stuart Street Kingston ON Canada K7L 2V7 Tel: 613 549 6666 ext. 2812 Fax: 613 548 2428 Email: [email protected]

Project Assistant

Lauren Murch Clinical Evaluation Research Unit Kingston General Hospital Angada 4, 76 Stuart Street Kingston ON Canada K7L 2V7 Tel: 613 549 6666 ext. 4146 Fax: 613 548 2428 Email: [email protected]

Technical Support

Fernando Ferrer Kingston General Hospital Angada 4, 76 Stuart Street Kingston ON Canada K7L 2V7 Tel: 613 549 6666 ext. 3695 Fax: 613 548 2428 Email: [email protected]

mailto:[email protected]



Acronyms

ABGs Arterial Blood Gases

APACHE II Acute Physiology and Chronic Health Evaluation II

CCN Critical Care Nutrition

CERU Clinical Evaluation Research Unit

CRF Case Report Form

eCRF Electronic Case Report Form

EN Enteral Nutrition

FTE Full time equivalent

GCS Glasgow Coma Score

ICU Intensive Care Unit

PA Project Assistant

PL Project Leader

PN Parenteral Nutrition

QI Quality Improvement

RD Registered Dietitian

RT Respiratory Technician/Therapist


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General Guidelines Ethics As this is a quality improvement (QI) project, ethical committee approval is not usually required. We have received ethics approval from Queen’s University, Kingston, Ontario, Canada to conduct this survey and publish the results. However, you may still want to contact your local ethics committee to check if additional approval is needed. For more information please refer to the document ‘Preparing for Ethics Submission’ available on our website. Accessing the Website The Clinical Evaluation Research Unit (CERU) will provide a username and password only

to individuals who have registered to participate in the International Nutrition Survey 2009, and to those that have been granted access by these registrants.

The Web Based Data Capturing System for the International Nutrition Survey can be accessed by following the International Survey login link on the www.criticalcarenutrition.com website, or directly at https://ceru.hpcvl.queensu.ca/CCN/.

All users must log onto the website using their own username and password prior to data entry.

Prior to accessing the website, first ensure that your browser is configured appropriately. For more information please refer to the help document on our website and on the login page.

When you log in, you will be taken to the appropriate page based on the ICUs that you have access to. If you are registered for more than one ICU, you will be taken to the ‘My ICUs’ page. If you are registered for a single ICU, you will be taken to the appropriate ICU status page.

Your user profile and password can be changed at any time by clicking the appropriate links on the International Nutrition Survey home page.

Completion of Electronic Case Report Forms All data collection activities will be completed on the web. Only patients meeting inclusion criteria should be entered on the web. See page 14. Dates are entered using YYYY/MM/DD format i.e. 2009/09/16. To ensure that proper date

format is obtained, click on the calendar icon and select the appropriate date. The date field will automatically be completed for you.

Enter all times using the 24-hour period format i.e. 22:37. To ensure a proper time format the web system will automatically enter a colon for you or you can manually enter a colon or semi-colon.

o Midnight (24:00 hours) should be entered as 00:00 o Enter all times as four digit codes (e.g. 7:26AM must be entered as 07:26)

To access eCRFs single click the appropriate link using the left side of your mouse. The data field only supports numerical data and will not recognize a unit suffix (e.g. Kg,

Kcal, mmol). Enter all data without units. All units are displayed next to the appropriate data field.

To expand a menu or taxonomy click on ‘+’ next to the title of the menu/taxonomy. To collapse the menu or taxonomy click on ‘-‘.

Do not press ‘enter’ on your keyboard to skip to the next field on an eCRF; this could cause you to be directed to the next page of data entry, and the current page may not be saved. Please use the ‘tab’ key or simply click on the field for which you wish to enter data for.


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The RESET form button will take you back to the last saved version. The EXIT form button will take you back to the ICU or Patient Status page.

All data fields MUST be completed. The web based data entry system has been programmed with various range checks to simplify the query process. In the event that you leave a data field blank or the values that you have entered are beyond web ranges, you will receive an input warning either directly on the form or under ‘Outstanding Issues’ on the Patient Status page. Please follow the instructions on the screen to “fix” the data and resolve the query.

Edit data entered on the web To edit previously saved information, access the appropriate eCRF, change the appropriate field(s) and save the form. To ensure Good Clinical Practice is maintained, all changes will be tracked and logged by the computer program. You cannot delete patients. Please contact technical support if you need to delete a date, or contact the Project Assistant if you have any other queries regarding editing or deleting data. Duration of Data Collection All daily nutrition data needs to be collected from Study day 1 and each day following

until day 12 unless ICU discharge (actual) or death occurs before day 12

Study Day 1 is from ICU admission to the end of your 24 hr flowsheet.

Study Day 2 and subsequent days starts at the time the ICU chart starts until it ends 24 hours later (eg from 07:59 on the 15 May 08 until 08:00 on the16 May 08).

If a patient is re-admitted to your ICU within 48 hrs of discharge, consider this to be a continuation of the previous stay. If a patient is re-admitted to your ICU after 48 hours of discharge, this is not considered to be a continuation of previous stay and patient cannot be included in the survey again.

Time frames for completion of data entry The web pages are to be completed retrospectively but it is encouraged that data is entered

online as soon as possible after it is collected. Deadline for completion of data entry:

o 1st December 2009 o If you have concerns regarding this deadline date, please contact the Project

Assistant

The web based data entry system has been programmed with various checks to simplify the query process. When proceeding with the data entry, please follow the order in which the forms appear. This will reduce the ‘outstanding issues’ that you will encounter. Finalizing Patients The web based data entry system has been programmed to recognize when the patient is eligible for finalization (i.e. no outstanding queries and a minimum of three days data entered). At this point, you can access and complete the Outcomes page for this patient and the patients’ status will change to ‘Finalized’. When all 20 patients have been finalized, navigate back to the ICU status page and click on “Edit ICU Information”. Scroll down and select the box that asks ‘Is data entry finalized at your ICU?’.


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Critical Care Nutrition Website

The Critical Care Nutrition website will be the gateway for accessing the web application’s login page. Go to the website www.criticalcarenutrition.com and click on ‘Register / Login’ under ‘International Survey 2009’ or access the login site directly at https://ceru.hpcvl.queensu.ca/CCN. Regular updates and useful information regarding the International Nutrition Survey will also be posted on this website so please check it regularly.

Webshot of www.criticalcarenutrition.com


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Survey Login Page and Registration User and ICU Site Registration can be completed any time between September 1st 2009 and September 16th 2009. We will notify all individuals that have expressed interest in participating in the survey when registration is open. Prior to entering data for your ICU, you will first need to create a user account for your ICU. This only needs to be completed once. Although several individuals can have access and enter data for your ICU site, we ask that the individual coordinating the survey at your ICU site take responsibility for this initial registration process.

Note that you will need to register even if you have previously participated in the survey in 2007 or 2008. Your previous username and password are no longer active.

User Registration Go to survey login page and click on ‘Create a new login account’. Complete the questions about yourself (Form A, Part A). Complete your login information (i.e. select and confirm a password and complete

human user verification). Click on ‘Save User’. You will be sent an e-mail confirming that you have successfully registered your ICU site

and you will be provided with your username. All usernames start with the prefix ccn followed by four digits.

ICU Registration Go to the survey login page and enter your username and password. You will be asked to complete questions about your hospital and ICU (Form A, Part B). Click on ‘Save ICU’. You will be directed to the ICU status page and can begin to enter patient data. If you wish to register more than one ICU, on the ICU status page, click on

‘Register New ICU’. o After clicking on ‘register new ICU’, you will be directed to the hospital

registration page, which you must fill out for each ICU, even if ICUs are located in the same hospital. After completion of this page, you will be directed to the ICU registration page.

You can edit your user profile and hospital / ICU details or change your password at any time by following the appropriate links.

Grant Permission to Other Users If you wish to grant permission for other users, on the ICU status page, click on ‘grant

permissions for this ICU to other users’, enter their e-mail addresses and click on ‘grant permissions’. This will generate an e-mail to new users with a username and temporary password to access the survey.


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Consent to participate: Checking this box tells us that you have read the information about the study and understand its purpose. It will allow us to compute benchmarked site reports comparing your performance with other ICUs in the dataset. All data will be aggregated, so that individual patients will not be identifiable and other sites will not be able to identify your ICU. Consenting to participate also allows us to correctly acknowledge your participation on the website and other publications.

Password: Select a password for your personal account. The password is case sensitive (i.e. it must be typed with the required capitalization) and must be at least 6 characters long. Do not type spaces between characters and do not use repeating characters (i.e. aaaaaa). To secure your password please select a combination of characters that will not be easily guessed by others, and don’t write down your password or share it with anyone else.

Forget your Password? : If you forget your password, click on the ‘forget your password?’ tab on the login page. Enter your e-mail address and complete the human user verification. You will be sent an e-mail with your username and a temporary password. Please change your password when you next login to the survey.

Human User Verification: You must type the letters or numbers you see in the box to confirm that a person is trying to access the survey and not an automated program. This helps to prevent automated programs from misusing the survey.

Registration e-mail: Please be aware that your username will be sent to you by e-mail shortly after you register (or after you are granted permissions), as the source of the e-mail may not be recognized by your provider please remember to also check your junk mail in the event that the survey e-mail is diverted to this folder.

ICU Registration: Although you may be aware of the answers to these questions about your hospital and ICU, we request that you ask the medical or nursing director of your ICU to answer questions related to the type of ICU and case mix.

Multiple ICUs: If your hospital has multiple ICUs, please enter YES when prompted, enter your ICU name. Make sure that you select a name for your ICU that is distinct from the other ICUs in your hospital (e.g. medical, surgical, trauma, neuro)

Type of Hospital: A teaching hospital is a hospital that provides training to medical student and residents. If your hospital only has occasional medical students/residents, record your hospital as a non-teaching hospital.

ICU Structure: Open ICUs are sites where patients are under the care of an attending physician (e.g. internist, family physician, surgeon) with intensivists (i.e. physician with training in critical care) consulted as necessary. Closed ICUs are sites in which patients are under the care of an intensivist, or care is shared between the intensivist and another attending physician.

Full Time Equivalent Dietitian: This is a measure of the amount of time the dietitian is dedicated to the ICU relative to a full-time position e.g. a FTE of 1.0 means that the dietitian works in the ICU full-time and a FTE of 0.5 means that the dietitian is in the ICU half-time, or two and a half days a week.

Grant permissions: If more than one person is entering data for your ICU, the primary user will be provided with an option to authorize other users to access your ICU site account. The new users will be sent an e-mail with their own username and password.


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Webshot of Login Page


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Welcome ‘Home’ Page

My ICUs This will be your ‘home’ page if you are registered for more than one ICU. This page will display a list of ICUs for which you have been granted permission to enter

data. The list will include the name of the ICU, the number of patients registered and the number of patients finalized.

Clicking on a specific ICU will take you to the ‘ICU Status’ page for that ICU. You can enter the ‘My ICUs’ page at any time by clicking on the appropriate links on the

menu. ICU Status Page This will be your ‘home’ page if you are registered for a single ICU. This page displays a list of all the patients registered at your ICU. The list includes the

patient number, basic demographic data, and the patient’s status. The statuses are: o In progress: The patient has less than three days of data entered, and/or there

are outstanding queries. The patient is therefore not eligible for finalization. o Eligible for finalization: The patient has no outstanding queries and has a

minimum of three days of data entered, and is therefore eligible for finalization. o Finalized: Data entry, including outcomes, is complete, with no outstanding

queries. Click on the line containing details about a specific patient to navigate to the Patient

Status page for that patient. Menu My ICUs. To view a summary of all registered ICUs and the number of patients

registered and finalized click on the ‘My ICUs’ left hand menu.

ICU Status. To view a summary of the number of patients registered at a single ICU and the number of patients finalized click on the ‘ICU Status’ left hand menu.

Register New Patient. To register a new patient, click on ‘register new patient’ on the

left hand side menu. Edit User Profile. To change your personal information click on ‘edit user profile’ on the

left hand side menu Change password. To change your password, click on ‘change password’ on the left

hand side menu. You will then be asked to enter your old password, and you will be able to enter and confirm a new password.

Contact Us. On the left hand side of the menu click on ‘contact us’ to view the contact details of the Project Assistant, Project Leader and Technical Support.

Help. To access documents related to the study and how to navigate the web-based data collection tool click on ‘help’ on the left hand side menu.


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Log Out. To log out of the web system and return to the login page click on “Log out’ on

the left hand side menu.

Webshot of ‘My ICUs’ Page

Webshot of ‘ICU Status’ Page


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Patient Status Page After clicking on a specific patient on the ICU Status Page you will be directed to the

Patient Status page. From this page you can view, enter data, or edit information for all International Nutrition

Survey related eCRFs. If you ‘save’ any eCRF, you will be directed back to this page.

To review or edit daily nutrition data, click on the row corresponding to the study day, or

click on “new observation” to add a new study day.

To review or edit EN or PN data, click on ‘Yes’ in the appropriate column. Outstanding issues for each patient can be viewed from the patient status page; click on

the ‘+’ sign beside ‘Outstanding Issues’ to view any issues for that patient. Click on ‘fix’ beside any issue to be directed to the page where the discrepancy or error exists.

It is a good idea to frequently check for outstanding issues, especially as you begin data entry, to ensure that you are entering data correctly

Webshot of Patient Status Page


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Screening You must begin to identify study patients on 16 September 2009 (or nearest possible date thereafter). The Screening Log is not part of the data collection process but has been developed as a tool to help you to identify which patients in the ICU meet the inclusion criteria. We will not be asking you to enter any specific information from this forum online. As a part of the final step of your online data entry process, however, we will be asking:

The total number of patients screened Of screened patients, the number intubated and ventilated within the first 48hrs of

admission to ICU Of screened, ventilated patients, the number who stayed in the ICU 3 days Number of eligible patients (i.e. ventilated within 48hrs and stayed 3 days) at your site

included in the survey Eligibility Criteria Inclusion:

Critically ill patients that are mechanically ventilated within the first 48 hours of admission to ICU.

Are in the ICU 3 days. Adult patients (i.e. 18 years).

Exclusion:

Patients on mask ventilation. Patients who were not ventilated within the first 48 hours of admission to ICU but

became ventilated after. Duration of Ventilation does not matter. Patients that were ventilated within the first 48 hours of admission to the ICU, then came off the ventilator and stay in the ICU > 3 days, still meet the eligibility criteria. If the patient is ventilated prior to admission to the ICU they meet the eligibility criteria. To identify the 20 eligible study patients, complete the following steps:

Go to your ICU and record the initials of ALL patients that are currently in your unit on this day in Column 1 of the Screening Log.

In Column 2, record only those patients from Column 1 that were intubated and ventilated within the first 48 hrs of admission to ICU or prior to ICU admission.

In Column 3, list only those patients from Column 2 that were in ICU 3 days. In Column 4, number the patients from Column 3 consecutively and these are your eligible

study patients. In Column 5, enter the number the patient was allocated by the web-based data capture

system (if different from Column 4). If you have less than 20 patients in your cohort of study patients on 16 September 2009,

continue to screen daily until you get a minimum of 20 consecutive patients. For patients that are just admitted and are ventilated, please follow them up for 72 hours to

see if they stay in the ICU 3 days, as they will also be included.


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Please keep the Screening Log to help track down which patient corresponds to which patient number in case we have data queries at a later date.

Consecutive Patient: the very next patient that was admitted that meets the criteria. Please do not ‘pick and choose’ patients randomly. Inclusion Criteria: o Include the patient if he/she is physically in the ICU at time of screening and meets the criteria even if

they are ready for discharge from the ICU and are waiting for a bed on the ward. o If the patient has had several admissions to the ICU, use the most recent admission. o If a patient is discharged from the ICU but re-admitted within 48 hours consider that this patient never

left the ICU. o If there is a patient in the ICU on 16 September 2009, is ventilated and was admitted less than 72 hours

ago, for example 14 September 2009, please follow the patient up and see if he/she stays in the ICU > 72 hours. If so, you will need to collect daily data from date of admission onwards to a maximum of 12 days (or death or discharge from the ICU). This can be done retrospectively at the end of the 12 days if you prefer.

o If the patient is in the ICU on 16 September 2009 and was admitted 01 August 2009, you need to collect daily from 01 August 2009 onwards until 12 August 2009.

o If charts are missing and you are unable to collect the relevant data for this patient, please exclude and include the next eligible consecutive patient.


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Patient Baseline Form This page is to be filled out once for each patient. ICU Admission: If a patient was admitted to the ICU, then discharged or transferred and then readmitted to the ICU, enter the date of the most recent admission to the ICU. If a patient is transferred from another ICU enter the date of admission to your ICU. Date and time of mechanical ventilation in ICU: This refers to invasive mechanical ventilation i.e. intubation with mechanical ventilation or tracheostomy with mechanical ventilation. This includes any positive pressure delivered via an endotracheal tube or a tracheostomy. This does not refer to non-invasive methods of ventilation such as BI-PAP or mask-CPAP. For the patient that is mechanically ventilated prior to admission to your hospital, this is the same as the admission date and time to your hospital, including patients undergoing outpatient surgery. Simply check the box ‘ventilation initiated prior to ICU admission’. Admission Category: Choose the most suitable from Medical or Surgical. If surgical indicate if this is elective or emergency surgery. Admission Diagnosis: View the ICU Admission Taxonomy provided (see Appendix). This is the diagnosis that resulted in the patient’s admission to ICU. If the patient’s admission category is Medical, choose the most suitable diagnosis from the Non-Operative list of the Taxonomy (i.e. 1 to 49). If the patient’s admission category is Surgical, choose the most suitable diagnosis from the Post-Operative list of the Taxonomy (i.e. from 50-86). If the Admission Diagnosis is not present in the taxonomy, look for the appropriate condition (based on admission category) and choose “Other” and type in the diagnosis. For example, if Admission Category is Non-Operative and Admission Diagnosis is Acute Renal Failure, choose “Other Metabolic disease (#44)” and type in “Acute renal failure”. We are specifically interested in reporting on patients with sepsis, pancreatitis, bariatric surgery, ARDS, and burns, therefore if a suitable diagnosis for a patient includes one of these conditions please select in preference to other diagnoses (e.g. if a patient is admitted with pneumonia or sepsis, select sepsis). Presence of Acute Respiratory Distress Syndrome (ARDS): ARDS is an acute lung condition characterized by PaO2:FiO2 < 200 mmHg in the presence of bilateral alveolar infiltrates on chest x-ray. You are not expected to diagnose ARDS. You only need to review the chart for the first 72 hrs from admission to the ICU for either a confirmed or suspected diagnosis of ARDS. If the chart says “? ARDS”, this is suspected ARDS, enter Yes. Highest/Lowest Blood Sugar within first 24 hours of admission: Indicate if blood sugar recorded within the first 24 hours of admission. If yes, please record the highest and lowest values in mmol/l. If reading is in mg/dL multiply by 0.0555 to convert to mmol/L. Head of Bed Elevation: Head of the bed should be observed at screening (i.e. when the patient is first included in the survey). For determining head of the bed elevation, use the device that the ICU bed is equipped with. If no such device is available, you will need to estimate the angle and we suggest that you do this with another team member i.e. RN, RT, etc. When you are estimating, please note if the patient has pillows under his/her head. If there are pillows, make sure that you record the angle at which the patient’s trunk meets the bed instead of the angle between the head and the pillow.


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See figure below:

Incorrect angle

Correct angles

Head of Bed Elevation is the only data element to be completed prospectively, consequently it is an OPTIONAL field. APACHE II Score: If routinely calculated directly enter score, if unavailable, leave field blank and you will be directed to the Apache II Online Worksheet.

Dates must be in a logical sequence. Start of Mechanical Ventilation cannot be more than 1 day before ICU admission

and cannot be more than 2 days after ICU admission. If mechanical ventilation initiated prior to ICU admission (e.g. patient

transferred from another ICU), tick the box that says ‘ventilation initiated prior to ICU admission’. Date and time will be set the same as ICU admission.

If only one blood sugar was recorded within the first 24 hours of admission enter the same value for the highest and lowest blood sugar.

Logic Alert


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Webshot of Patient Baseline Form


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APACHE II Note: Use values from the first 24 hours from admission to ICU.

You will only need to complete this page if the patient does not have an Apache II score

entered in the patient baseline form. Please note that, as in all forms, pressing the ‘enter’ key will save the form and direct you

back to the patient status page. Please click on the field you would like to enter a value for, or use the ‘tab’ key to jump between fields.

Enter the lowest and highest value recorded in the source documentation within the first 24 hours from admission to ICU. The value that generates the highest severity score will be selected by the web application.

When you enter the values in the right-hand columns, the severity score will be automatically calculated.

Note: If variables are not available from the first 24 hrs, go outside the 24-hour window and use the data closest to ICU admission. Use the Comment Box to indicate that you used data outside the 24-hour window.

Age will be automatically transferred from previous web page. Temperature: Enter the value and indicate, core, oral, axilla or tympanic listed in the second

drop box. o The program will re-calculate to the appropriate core temperature. o Rectal, tympanic, temporal, and bladder temperatures are considered as core

temperature. o For manual calculations of APACHE: To obtain the core temperature: if oral

temperature is reported, add 0.5 C to oral temperature; if axilla temperature is reported, add 1.0C.

Enter the systolic and diastolic blood pressures in the appropriate box. Once these values have been entered the Mean Arterial Pressure (MAP) value will automatically be calculated and entered in the right-hand column.

Heart Rate: enter the highest and lowest value. Respiratory rate: (either ventilated, or non-ventilated) Oxygenation:

o If the FiO2 is > 0.5, the PaCO2, and the PaO2 boxes appear. Enter the values into the appropriate boxes. Again, the program will calculate the A-aD02 and enter the value in the right-hand column. For the purposes of this trial the barometric pressure value will be standardized at 713.

o If the FiO2 is < 0.5, only the PaO2 box will appear. Enter the value. o If no arterial blood gases (ABGs) are available, check the appropriate box and

enter the HCO3 in place of arterial pH. Serum HCO3 should only be used if there are no ABGs available in the previous 24 hours.

o For manual calculations of APACHE: In the event that the FiO2 is > 0.5 and multiple gases are available, you will need to calculate the A-aD02 (alveolar arterial gradient) manually to obtain the highest and lowest scores. To calculate the A-aD02, you must use the variables from the same gas.

Arterial pH. Serum Sodium: the unit of measure is mmol/L. Serum Potassium: the unit of measure is mmol/L.


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Serum Creatinine: the unit of measure is µmol/L. If you require a definition of Acute Renal Failure, click on “Explain” and definitions will be provided.

Hematocrit: enter this value as a percentage. White Blood Cells (total/mm3)(in 1000’s). Glasgow Coma Score (GCS): If this patient has a GCS documented in their chart for the first

24 hours after ICU admission, directly enter the score. Otherwise, to determine the GCS choose the best eye, verbal and motor response for the first 24 hours after ICU admission. If the patient is sedated, then go back to the period when the patient was not receiving sedation or approximate what the score would be if the sedation where to be removed. See worksheet or CCN website for GCS flow sheet. If you are unable to calculate a pre-sedation GCS, assume that the GCS is normal and enter a score of 15. Enter the values in the 3 separate categories and the GCS will automatically be calculated.

Eye Opening: 4-Spontanous

3- To speech 2- To Pain 1- None

Verbal Response: 5- Oriented

4- Confused 3- Inappropriate words 2- Incomprehensible words 1- None

Best Motor Response:

6- Obeys commands 5- Localizes to pain 4- Withdraws from pain 3- Abnormal flexion 2- Extension 1- None

Chronic Health Points: Choose one of the 3 categories for patients with a history of severe organ system insufficiency or immunocompromised – Click “Explain” box on the left hand side of the screen for definitions.

When all the categories are completed, click on the box labeled “Save Apache II Form” and the system will automatically save and calculate your Apache Score.

The APACHE II worksheet is a tool provided to help you calculate your patients’ APACHE II scores. However, if you are more familiar with other tools, please feel free to use these and directly enter the APACHE II score on the Patient Baseline Form. Alternative electronic and paper-based worksheets are available on our website under International Nutrition Survey / Resources


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Webshot of Apache II Form


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Baseline Nutrition Assessment This form is to be filled out once for each patient. Record height in metres and weight in kilograms at time of ICU admission. If unable to

obtain “actual” height or weight, use estimated height and weight or that obtained from family members and check the appropriate box to indicate that data was estimated.

For weight used to determine prescribed energy requirements, choose from the list. Code Weight 1 Actual (ABW) (Measured or estimated) 2 Ideal (IBW) based on Hamwi formula 3 Ideal (IBW) based on BMI 20-25 Kg/m2 4 Adjusted by 25% (ABW x 0.25 + IBW) 5 Adjusted by 40% (ABW x 0.4 + IBW) 6 Adjusted average ((ABW + IBW) x 0.5) 7 No weight used in calculation 8 No assessment completed 9 Other, please specify For determination of energy requirements choose from the list. Code Predictive Equation 1 Harris Benedict Equation 2 Schofield Equation with no adjustment for stress and

activity 3 Schofield Equation with adjustment for stress and/or

activity 4 Mifflin-St. Jeor Equation 5 Ireton-Jones Equation 6 Weight based <20 Kcal/Kg 7 Weight based: 20-24 Kcal/Kg 8 Weight based: 25-29 Kcals/Kg 9 Weight based: 30-35 Kcal/Kg 10 Provide 1200 – 1499 Kcal as standard 11 Provide 1500-2000 Kcal as standard 12 Indirect calorimetry 13 Other, please specify For prescribed energy intake enter the kilocalories provided by the goal regimen (i.e.

maximum rate/volume determined at the initial assessment) for EN/PN according to the dietitians’ or physicians’ recommendation.

o e.g. If the dietitian recommends a starting rate of 25 ml/hr on day 1 with a final rate of 75 ml/hr by day 3, calculate the calories and protein that the final rate = 75ml/hr X 24 would provide

For prescribed protein intake enter the grams provided by the goal regimen (i.e. maximum

rate/volume determined at the initial assessment) for EN/PN according to the dietitians’ or physicians’ recommendation.


23

For those on EN and PN, please record the kilocalories and protein from the combined prescription of EN and PN.

o Weight: Enter the patient’s actual weight in kilograms. Do not enter the weight used to estimate the patients

nutritional requirements if it differs from the patients actual weight. Check the box that says “weight estimated” if the weight was obtained by enquiring of relatives or estimated by a clinician. Use “dry weight” (i.e. weight in the absence of fluid overload) if fluid retention is present. See CCN website for height and weight conversion charts

o Height: Enter height in meters.Check the box that says “height estimated” if the height was obtained by enquiring of relatives or estimated by a clinician. See Appendix or CCN website for height conversion charts.

o Weight used to determine requirements: If an unadjusted estimated weight is used to calculate nutritional requirements, select ‘actual’ body weight.

o Prescription: Record total kilocalories i.e. include the kilocalories from protein. If the prescription changes over the days of observation, calculate the average prescribed calories and protein.

o If a nutritional assessment was not completed, calculate prescription as 25 kcal/kg for energy and 1g/kg protein. (e.g. an 80kg male patient would have a prescription of 2000kcal and 80g protein).

Webshot of Baseline Nutrition


24

Daily Nutrition Data This form is to be filled out for each patient daily. The study day will automatically appear on the screen.

Study Day 1 is from ICU admission to the end of your 24 hr flowsheet. Study Day 2 and subsequent days starts at the time the ICU chart starts until it ends 24 hours later. (e.g. from 08:00 on the 17 September 09 until 07:59 on the 18 September 09)

For each study day, indicate “Yes” or “No” to indicate if patient received nutrition. If patient is on both enteral and parenteral nutrition on the same day, click the ‘yes’

response in both places (“Enteral nutrition” and “Parenteral nutrition”). If patient received EN (either EN only, or EN and PN), you may click the “Enter EN”

button to save changes and be automatically directed to the Enteral Nutrition page. If patient received PN (either PN only, or PN with EN), you may click the “Enter PN”

button to save changes and be automatically directed to the Parenteral Nutrition page.

Click on ‘save’ to save the form and return to the patient status page. EN and PN pages can also be accessed from the patient status page. If you have

selected EN or PN in the daily nutrition data, “Yes” will appear in the EN or PN column for that study day. Simply click on “Yes” in the appropriate column to be directed to the EN or PN page corresponding with that study day.

o Blood sugars: record first blood sugar reading closest to 08:00 hrs. This can be either serum or capillary. If

no blood sugars were recorded for that day, click on ‘none recorded’. o Hypoglycemic episodes: Record any blood sugar reading <3.5mmol/l (63 mg/dL)(up to 3 episodes per day). If

reading is in mg/dL multiply by 0.0555 to convert to mmol/L. o Insulin: Add up the total number of units of insulin over the 24 hr period regardless of route or type. If the

patient is receiving 2 different types of insulin add together to provide total units of insulin. If the patient did not receive insulin click on ‘no insulin received’.

o Supplemental Glutamine: This refers to glutamine given as a supplement over and above what would normally be present in the standard enteral or parenteral formula.

o Supplemental Selenium: This refers to selenium given as a supplement over and above what would normally be present in the standard enteral or parenteral formula.

o Propofol: Indicate Yes if continuous infusion ≥ 6 hrs and No if no propofol given or if continuous < 6hrs or provided intermittently. If Yes, indicate kilocalories received from propofol (provides 1.1Kcal/ml). Do not count propofol in kilocalories from EN/PN.

o Supplemental Prebiotics/Probiotics/Synbiotics: This refers to any prebiotics/probiotics/synbiotics given as a supplement over and above what would normally be present in the standard enteral formula. We define a probiotic as a commercial preparation of viable, defined microorganisms in sufficient numbers which alter the microflora (by implantation or colonization) in a compartment of the patient and by that may potentially exert beneficial health effects in this patient. We are not asking you to record the type of product or the dose.


25

Webshot of Daily Nutrition Data Page

If you do not have three days of daily data entered, you will not be able to proceed to complete the Outcomes page and finalize the patient. Proceed with entering data for the missing days.

Logic Alert

If you have accidentally entered an extra day, contact Technical Support stating your username, the patient number and patient day that you wish to delete.


26

Enteral Nutrition Data This form is to be filled out for each patient daily. The study day will

automatically appear on the screen. EN Formula: Using the taxonomy provided on the web, please record enteral

formula(s) received. See appendix for list of formulas. o You may select up to 3 formulas per day. In the event that the patient

receives more than 3 formulas, select the 3 that provided the largest volumes.

o On subsequent days, answer yes or no to the question “Has the EN formula(s) changed since previous day?”. If you click “Yes” the taxonomy will appear and you can select new formulas.

Kilocalories Received: The total calories will need to be calculated by the dietitian daily as follows:

o Include calories from protein o Include calories from other supplements. o Do NOT include calories from propofol o Do NOT include calories from IV solutions.

Protein Received: The total protein will need to be calculated by the dietitian

daily as follows: o Include protein from additional supplements, if applicable. o Do NOT include glutamine

If patient is on a combination of Enteral Nutrition and Parenteral Nutrition, please

calculate the calories received from each separately (i.e. do not include calories from PN on EN page).

Location of feeding tube: Pick one of the options from the drop down box to

indicate the location of feeding tube (refers to any oro/naso-gastric or feeding tube). Choose one of the following options:

1. “Gastric confirmed” if placement was confirmed by an X ray on that day 2. “Gastric presumed” if placement was confirmed by an X-ray earlier but

not on that day 3. “Post-pyloric duodenal confirmed” if placement was confirmed by an X-

ray on that day 4. “Post-pyloric duodenal presumed” if placement was confirmed by an X-

ray earlier but not on that day 5. “Post-pyloric jejunal confirmed” if placement was confirmed by an X-Ray

on that day 6. “Post-pyloric jejunal presumed” if placement was confirmed by an X-ray

earlier but not on that day 7. No tube in place on that day


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If the location of the feeding tube changes within the day, please choose the location that was

used for the majority of the day. If gastric was used for half the day and post-pyloric for the other half, choose post-pyloric.

If the location of the feeding tube was confirmed by pH testing, auscultation and/or some other

standard method, choose location of feeding tube “confirmed”.

Feeding Interruptions: Indicate Yes or No if enteral nutrition was ever interrupted today. If yes, enter the total duration of feed interruption (i.e. if the EN feeds were stopped from 10:00 to 10:45 and then again 13:15 to 20:20 enter 8hrs, 50mins). Select the reason that EN feeds were interrupted from the list below. If more than one reason, select all that apply (hold control and click to select multiple options).

Code Reason 1 Fasting for endotracheal extubation or intubation 2 Fasting for other bedside procedure 3 Fasting for operating room procedure 4 Fasting for radiology suite procedure 5 Intolerance to enteral feeding – high gastric residuals 6 Intolerance to enteral feeding – increased abdominal girth or abdominal distension 7 Intolerance to enteral feeding – vomiting / emesis or diarrhea 8 Intolerance to enteral feeding –subjective discomfort 9 No enteral access available / enteral access lost, displaced or malfunctioning 10 Inotropes, vasopressor requirement 11 Subject deemed too sick to continue enteral feeding 12 Enteral feeding formula not available 13 Reason for EN interruption not known

Motility Agents: Choose from the options below. We are not asking you to

record the route of administration or dose. If the patient has been prescribed combination therapy, please select all motility agents prescribed (hold control and click to select multiple options).

Code Reason 1 Metoclopramide 2 Motilium 3 Erythromycin 4 Other: Specify______________ 5 None


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Webshot of Enteral Nutrition Page


29

Parenteral Nutrition Data This form is to be filled out for each patient daily. The study day will automatically appear on the screen. PN solution: Using the taxonomy provided on the web, please record parenteral

solution(s) received. See appendix for list of solutions. o You may select up to 3 solutions per day. In the event that the patient

receives more than 3 solutions, select the 3 that provided the largest volumes.

o We are asking you to record macronutrient solutions (i.e. amino acids, glucose, and lipids). DO NOT include micronutrient solutions (i.e. trace elements, vitamins).

Reason EN not provided: Choose from the taxonomy, and if the reason for PN

is not listed, select ‘other’ and specify. On subsequent days, answer yes or no to the question “Has the reason EN not provided changed since the previous day?”. If you click “Yes” the taxonomy will appear and you can select a new reason.

Code Reason 1 No clinical reason 2 Mechanical bowel obstruction 3 Bowel ischemia 4 Small bowel ileus 5 Small bowel fistulae 6 Gastrointestinal perforation 7 Short Gut Syndrome 8 Hemodynamic instability 9 Proximal bowel anastomosis 10 Not tolerating enteral feeding 11 No access to small bowel 12 Pancreatitis 13 Gastrointestinal bleed 14 Gastrointestinal surgery 15 Other: Specify______________ Kilocalories Received: The total calories will need to be calculated by the

dietitian daily as follows: o Include calories from protein. o Include calories from other supplements. o Do NOT include calories from propofol. o Do NOT include calories from other IV solutions.

Protein Received: The total protein will need to be calculated by the dietitian

daily as follows: o Include protein from supplements, if applicable. o Do NOT include glutamine.


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If patient is on a combination of Enteral Nutrition and Parenteral Nutrition, please calculate the calories received from each separately.

Click on ‘save’ to save the form and return to the patient status page.

Webshot of Daily Parenteral Nutrition Page


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60-day Outcomes

All outstanding issues must be addressed before you can access this page. The outstanding issues for each patient can be viewed by clicking the ‘+’ beside ‘Outstanding issues’ on the patient status page. It is a good idea to frequently check for outstanding issues, especially as you begin data entry, to ensure that you are entering data correctly.

This form is to be completed upon discharge from ICU/hospital or if the patient dies. This form is to be completed once for each patient. You may need to wait until day 60 (from admission to ICU) to complete some of the questions. On the Patient Status Page under Outcomes and Follow-up select ‘Finalize

Patient’. You will be directed to the Outcome page.

Enteral/Parenteral Nutrition First Initiated: Indicate when EN/PN was initiated. o If started prior to ICU admission and continued in ICU, date and time of

enteral nutrition started will become ICU admission date/time. o If initiated in ICU, record the date and time enteral nutrition was started in

ICU. “Did patient die in hospital/ICU?” “Yes” or “No”

o If “Yes”: o You will be prompted to provide date and time of actual death. Note:

Death date & time will be same as Hospital & ICU discharge date and time, therefore you do not complete the date fields, simply indicate that hospital/ICU discharge date same as date of death.

o If “No” o You will be prompted to indicate if the patient is still in ICU or hospital at

day 60 (from admission to ICU). If the patient was discharged, you will be prompted to enter hospital/ICU date and time.

When was mechanical ventilation discontinued in the ICU? Indicate when mechanical ventilation discontinued.

If patient is discharged from ICU while still ventilated (for example, transfer to step-down unit or transfer to another hospital), discontinuation date and time of ventilation is same as ICU discharge date and time. In addition, please make a comment in the Comment Box describing the situation. Death or ICU/hospital discharge marks the end of data collection. We are not asking you to follow-up for 60 days after discharge home or transfer to another healthcare facility.

Click ‘Finalize Patient’ to save the form and be directed back to the patient status page. If there are outstanding queries on the Outcome page, the patient’s status will be listed as ‘in progress’ on the patient status page. If the patient was finalized successfully, the patient’s status will be listed as ‘finalized’ on the patient status page.


32

If ICU discharge date is not consistent with the duration of the daily data that you have entered, an input warning will be generated, as follows “Date EN initiated does not match observation data” You may either correct the ICU discharge date or enter additional daily data to the end of the study period

Logic Alert

Webshot of Outcomes


33

Finalizing Data Entry To determine when the data entry has been completed, a data finalization process has been incorporated into the web based data entry system. When you have completed data entry for all 20 patients navigate back to the ICU status page and click on “Edit ICU Information”. Scroll down and select the box that asks ‘Is data entry finalized at your ICU?’ Make sure that the data you have entered is accurate to the best of your knowledge before you finalize the data.

As part of the completion of your data entry process, you will also be asked the following questions (answers can be obtained by reviewing your screening log):

The total number of patients screened Of screened patients, the number intubated and ventilated within the first 48hrs

of admission to ICU Of screened, ventilated patients, the number who stayed in the ICU 3 days Number of eligible patients (i.e. ventilated within 48hrs and stayed 3 days) at

your site included in the survey


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35

Appendices

Appendix 1 ICU Admission Diagnosis Taxonomy

NON-OPERATIVE CONDITIONS Choose from this list if admission category is medical Cardiovascular / vascular: 1. Cardiogenic shock 2. Cardiac arrest 3. Aortic aneurysm 4. Congestive heart failure 5. Peripheral vascular disease 6. Rhythm disturbance 7. Acute myocardial infarction 8. Hypertension 9. Other CV disease: __________ Respiratory: 10. Parasitic pneumonia (ie.pneumocystis carinii) 11. Aspiration pneumonia 12. Respiratory neoplasm (inc. larynx, trachea) 13. Respiratory arrest 14. Pulmonary edema (non-cardiogenic) 15. Bacterial / Viral pneumonia 16. Chronic obstructive pulmonary disease 17. Pulmonary embolism 18. Mechanical airway obstruction 19. Asthma 20. Other respiratory disease: ___________ Gastrointestinal: 21. Hepatic failure 22. GI perforation/obstruction 23. GI bleeding due to varices 24. GI inflammatory disease (ulcerative colitis, crohn’s disease) 25. GI bleeding due to ulcer/laceration 26. GI bleeding due to diverticulosis 27. Pancreatitis 28. Other GI disease: __________ Neurologic: 29. Intracerebral hemorrhage 30. Subarachnoid hemorrhage 31. Stroke 32. Neurologic infection 33. Neurologic neoplasm 34. Neuromuscular disease 35. Seizure 36. Other neurologic disease: _________ Sepsis: 37. Sepsis (other than urinary tract) 38. Sepsis of urinary tract origin Trauma: 39. Head trauma (with/without multiple trauma) 40. Multiple trauma (excluding head trauma) Metabolic: 41. Metabolic coma 42. Diabetic ketoacidosis 43. Drug overdose 44. Other metabolic disease:_____________ Hematologic: 45. Coagulopathy //neutropeniathrombocytopenia 46. Other hematologic condition: __________

Other: 47. Renal disease:_____________________ 48. Burns 49. Other medical disease: __________ POST-OPERATIVE CONDITIONS: Choose from this list if admission category is surgical Vascular / cardiovascular: 50. Dissecting/ruptured aorta 51. Peripheral vascular surgery (no bypass graft) 52. Valvular heart surgery/CABG 53. Elective abdominal aneurysm repair 54. Peripheral artery bypass graft 55. Carotid endarterectomy 56. Other CV disease: _____________ Respiratory: 57. Respiratory infection 58. Lung neoplasm 59. Respiratory neoplasm (mouth, sinus, larynx, trachea) 60. Other respiratory disease: __________ Gastrointestinal: 61. GI perforation/rupture 62. GI inflammatory disease 63. GI obstruction 64. GI bleeding 65. Pancreatitis 66. Liver transplant 67. GI neoplasm 68. GI cholecystitis / cholangitis 69. Other GI disease: _____________ Neurologic: 70. Intracerebral hemorrhage 71. Subdural/epidural hematoma 72. Subarachnoid hemorrhage 73. Laminectomy/other spinal cord surgery 74. Craniotomy for neoplasm 75. Other neurologic disease: ___________ Trauma: 76. Head trauma (with/without multiple trauma) 77. Multiple trauma (excluding head trauma) Renal: 78. Renal neoplasm 79. Other renal disease: _____________ Gynecologic: 80. Hysterectomy Orthopedic: 81. Hip or extremity fracture Bariatric Surgery: 82. Laparoscopic Banding 83. Laparoscopic Gastric Bypass 84. Open Gastric Bypass (Roux-en-Y) 85. Vertical Banded Gastroplasty Other: 86. Other surgical condition:____________

Appendix 2 Enteral Nutrition Taxonomies

A. Abbott International

Code Formula Name Code Formula Name A1 AlitraQ A24 Osmolite with Fiber A2 Edanec A25 Osmolite HN A3 Edanec HN A26 Osmolite HN Plus A4 Ensure A27 Osmolite High Protein A5 Ensure HP A28 Oxepa A6 Ensure Plus A29 Optimental A7 Glucerna A30 Optimental 1.0 A8 Glucerna Select A31 Perative A9 Jevity A32 Pivot 1.5 Cal

A10 Jevity 1 Cal A33 Promote A11 Jevity 1.2 Cal A34 Promote with Fiber A12 Jevity 1.5 Cal A35 Pulmocare A13 Jevity Plus 1.5 k/cal A36 Pulmocare II A14 Jevity 2 with FOS A37 Suplena A15 Jevity with FOS A38 Two Cal HN A16 Jevity HiCal A39 Vital A17 Jevity Plus A40 Vital HN A18 Jevity Promote A41 Supplement: Juven A19 Nepro A42 Supplement: Polycose powder A20 Osmolite A43 Supplement: Polycose Liquid A21 Osmolite 1 Cal A44 Supplement: Promod A22 Osmolite 1.2 Cal A45 Supplement: Prosure A23 Osmolite 1.5 Cal A46 Other Abbott Product (please specify)


36

C. Nestle

Code Formula Name Code Formula Name

C1 Boost 1.0 Standard C24 Nutren Replete Fiber C2 Boost 1.5 Plus Calories C25 Nutrihep C3 Crucial C26 Peptamen C4 Compleat C27 Peptamen 1.5 C5 Diabetisource AC C28 Peptamen OS

C6 Fibersource HN C29 Peptamen OS 1.5 C7 Glutasolve C30 Peptamen with Prebio 1 C8 Impact C31 Peptamen AF 1.2 with Prebio C9 Impact Glutamine C32 Renalcal

C10 Impact with Fiber C33 Resource 2.0 C11 Impact 1.5 C34 Resource Diabetic C12 Isosource HN C35 Tolerex C13 Isosource HN with fibre C36 Vivonex TEN C14 Isosource VHN C37 Vivonex Plus C15 Isosource 1.5 Cal C38 Vivonex RTF C16 Novasource Renal C39 Supplements- Beneprotein Instant Protein Powder C17 Nutren 1.0 C40 Supplements - Microlipid C18 Nutren 1.0 Fiber C41 Supplements – Resource Benecalorie C19 Nutren 1.5 C42 Supplements - MCT Oil C20 Nutren 2.0 C43 Supplements-Resource Glutasolve C21 Nutren Glytrol C44 Supplements: Resource Arginaid C22 Nutren Pulmonary C45 Supplements- Resource Benefiber C23 Nutren Replete C46 Other Nestle Product

D. Novartis: Items which were formerly found under Novartis are now considered a part of Nestle. See ‘C. Nestle’ above.

E. Nutricia

Code Formula Name Code Formula Name E1 Cubison E14 Nutrison Concentrated E2 Diason E15 Nutrison Pre E3 Nutrison Standard E16 Nutrison Low Energy Multi Fibre E4 Nutrison Multi Fibre E17 Nutrisorb Low Energy E5 Nutrison Protein Plus Multi Fibre E18 Nutrisorb Low Energy Soy Multi Fibre E6 Nutrison Protein Plus E19 Peptisorb E7 Nutrison1000 Complete Multi Fibre E20 Supplement: Calogen E8 Nutrison 1200 Complete Multi Fibre E21 Supplement: Protifar E9 Nutrison Energy Multi Fibre E22 Supplement: Polycal Powder / Fantomalt E10 Nutrison Energy E23 Supplement: Polycal Liquid E11 Nutrison Soya E24 Supplement: DuoCal E12 Nutrison MCT E25 Supplement: Fortimel E13 Nutrison Low Sodium E26 Other Nutricia Product


37


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G. Miscellaneous Companies

Code Formula Name G1 Baxter: Restore-X G2 MEAD JOHNSON: Portagen G3 Hormel Health: Immun-Aid G4 Hormel Health: Hepatic-Aid G5 Hormel Health: Glutasorb G6 Hormel Health: Propass G7 National Nutr ition: Argiment

G8 National Nutr ition: Argitein G9 National Nutr ition: Prosource liquid

G10 Nationa l Nutr ition: Prosource powder G11 Global Health: Procel G12 Medical Nutr ition: Pro-sta t G13 Victus Inc: Immunex Plus

G14 Wyeth: Enercal G15 Wyeth: Enercal Plus G16 Other

F. B.Braun Code Formula Name F1 Nutricomp Standard F2 Nutricomp Standard with Fibre F3 Nutricomp Standard with Fibre D F4 Nutricomp F5 Nutricomp Diabetes F6 Nutricomp Hepa F7 Nutricomp Intensive F8 Nutricomp Immun F9 Nutricomp MCT F10 Nutricomp Peptid F11 Nutricomp Energy F12 Nutricomp Energy Fibre F13 Other B.Braun Product

Appendix 3 Parenteral Nutrition Solution Taxonomy

A. Baxter Code Solution Name Code Solution Name

Amino Acids A1 BranchAmin 4% A2 15% CLINISOL® sulfite free A3 PREMASOL 6% A4 PREMASOL 10% sulfite free A5 RenAmin® A6 Synthamin® 9, 5.5% / 9.1 g N A7 Synthamin® 14, 8.5% / 14 g N A8 Synthamin® 17, 10% / 16.5 g N A9 TRAVASOL® 5.5% A10 TRAVASOL® 8.5% A11 TRAVASOL® 10%

Lipid A12 ClinOleic® 20% A13 Intralipid® 20% IV Emulsion A14 Intralipid® 30% IV Emulsion

Glucose A15 Glucose 5% A16 Glucose 10% A17 Glucose 15% A18 Glucose 20% A19 Glucose 40% A20 Glucose 50% A21 Glucose 70%

Multi-chamber Bags A22 CLINIMIX® E 2.75/5 A23 CLINIMIX® E 2.75/10 A24 CLINIMIX® E 4.25/5 A25 CLINIMIX® E 4.25/10 A26 CLINIMIX® E 4.25/25 A27 CLINIMIX® E 5/15 A28 CLINIMIX® E 5/20 A29 CLINIMIX® E 5/25 A30 OLICLINOMEL® N4-550 E A31 OLICLINOMEL® N4-720 E A32 OLICLINOMEL® N5-800 A33 OLICLINOMEL® N6-900 E A34 OLICLINOMEL® N7-1000 A35 OLICLINOMEL® N7-1000 E A36 OLICLINOMEL® N8-800 A37 CLINIMIX® N9G20E dual chamber A38 CLINIMIX® N14G30E dual chamber B. B. Braun Code Solution Name Code Solution Name

Amino Acids B1 Aminoplasmal® - 5% E B2 Aminoplasmal® - 10% E B3 Aminoplasmal® - 10% B4 Aminoplasmal® - 15% E B5 Aminoplasmal® - 15% B6 Aminoplasmal® Hepa 10%

Lipids B7 Lipidem®/Lipoplus® B8 Lipofundin® MCT/LCT 10% B9 Lipofundin® MCT/LCT 20% B10 Lipofundin® N 10% B11 Lipofundin® 20% N

Glucose B12 Glucose 10% B. Braun B13 Glucose 20% B. Braun B14 Glucose 40% B. Braun B15 Glucose 50% B. Braun B16 Glucose 70% B. Braun

Multi-chamber Bags B17 Nutriflex® Lipid B18 AMINOMIX® 2 B19 AMINOMIX® 1 B20 Nutriflex® B21 AMINOMIX® 3


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C. Fresenius Kabi Code Solution Name Code Solution Name

Standard Amino Acids C1 Aminoven® 5% C2 Aminoven® 10% C3 Aminoven® 15% C4 VAMIN® 14EF C5 VAMIN® 18EF C6 Other 5% Standard Amino Acid w or w/o

electrolytes C7 Other 10% Standard Amino Acid w or w/o

electrolytes C8 Other 15% Standard Amino Acid w or w/o

electrolytes Special Amino Acids

C9 Aminosteril® KE 10% C10 Aminosteril® N-HEPA 8% C11 Other hepatic solutions C12 Dipeptiven® C13 Glamin®/Glavamin® C14 Nephrotect® 10% C15 Other renal solutions C16 Vamin® Glucose C17 Other amino acid solutions with carbohydrates

Lipids C18 Intralipid® C19 Lipovenoes® 10% PLR C20 Lipovenoes® MCT 10% / 20% C21 Omegaven® C22 SMOFLIPID® C23 STRUCTOLIPID® C24 Structolipid® 20% C25 Other soybean oil lipid emulsions

Multi-chamber bags C26 Compleven® C27 Kabiven® central C28 Kabiven® peripheral C29 StructoKabiven® C30 SmofKabiven® C31 Aminomix® 1 Novum C32 Aminomix® 2 Novum C33 Aminomix® 3 Novum C34 Other 2 Chamber bags for central-venous

administration

D. Hospira Code Solution Name Code Solution Name

Amino Acids D1 Aminosyn® D2 Aminosyn® - RF 5.2% D3 Aminosyn® - RF 7% D4 Aminosyn® - with electrolytes D5 Aminosyn® - HBC 7% D6 Aminosyn® II [amino acid injection] D7 Aminosyn® II [dextrose injection] D8 Aminosyn® II 3.5% D9 Aminosyn® II 4.25% w/o electrolytes D10 Aminosyn® II 4.25% w electrolytes & calcium D11 Aminosyn® II 5% D12 Aminosyn® II 7% D13 Aminosyn® - HF 8% D14 Aminosyn® II 8.5% D15 Aminosyn® II 10% D16 Aminosyn® II 15% D17 Other Aminosyn® Products

Lipids D18 Liposyn® II D19 Liposyn® III D20 Liposyn® III 30%

Glucose D21 10% Dextrose injection USP D22 20% Dextrose injection USP D23 30% Dextrose injection USP D24 40% Dextrose injection USP D25 50% Dextrose injection USP D26 70% Dextrose injection USP

Multi-chamber bags D27 Nutrimix Dual Chamber TPN Delivery System D28


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Appendix 4 Height Conversion Table

One foot = 12 inches One inch = 2.54 centimeters

Feet/Inches

Inches

Centimeters

Feet/Inches

Inches

Centimeters

4ft 6 inch

54

137

5ft 10 inch

70

178

4ft 7 inch

55

140

5ft 11 inch

71

180

4ft 8 inch

56

142

6 ft

72

183

4ft 9 inch

57

145

6ft 1 inch

73

185

4ft 10 inch

58

147

6ft 2 inch

74

188

4ft 11 inch

59

150

6ft 3 inch

75

191

4ft 12 inch

60

152

6ft 4 inch

76

193

5ft 1 inch

61

155

6ft 5 inch

77

196

5ft 2 inch

62

157

6ft 6 inch

78

198

5ft 3 inch

63

160

6ft 7 inch

79

201

5ft 4 inch

64

163

6ft 8 inch

80

203

5ft 5 inch

65

165

6ft 9 inch

81

206

5ft 6 inch

66

168

6ft 10 inch

82

208

5ft 7 inch

67

170

6ft 11 inch

83

211

5ft 8inch

68

173

7ft

84

213

5ft 9inch

69

175

7ft 1 inch

85

216

Documents

Instruction Manual - Critical Care Nutrition...Clinical Evaluation Research Unit Kingston General Hospital Angada 4, 76 Stuart Street Kingston ON Canada K7L 2V7 Tel: 613 549 6666 ext