PP026-MON: Nutritional Support Team Performance is Related to Exclusive Dedication to the Team

Rationale: Our aim was to determine the national variation in assessment and provision of nutrition and its resource implications within the Welsh critical care community. Methods: All critical care units in Wales were contacted via email. At each unit a Dietitian and a Consultant in ICM were invited to complete an online survey. The units that failed to respond received follow up emails and telephone calls to ensure best response rate. Results: Of the 16 units contacted, 12 Dietitians and 12 Consultants responded sampling district general and university hospitals. Only 15% of units met the minimum dietetic requirement per bed, with 23% of centres having no dedicated dietetic time. None of the units reached optimum dietetic staffing levels of 0.1 WTE per bed. Only 50% patients receive a daily weekday review with 55% Dietitians never attending ICU rounds or MDT’s. 90% units initiate EN within 24 48 hours. 90% units utilize NJ feeding to achieve nutritional goals; via mainly endoscopically placed NJT. 80% units use <10 NJ tubes per annum. All units monitor gastric residual volumes; however there is considerable variation in threshold values for altering feeding rates or initiation of prokinetic agents. The majority of units calculate nutritional requirements using predictive equations. Only one unit documents nutritional requirements at the bedside. Less than 50% units calculate nutritional deficits, a third of which are highlighted via MDT meetings and two thirds via the medical notes. Conclusion: Nutrition support in critical care is staggeringly under-resourced with only two units meeting the minimum standard of dietetic staffing; in addition Dietitians appear inadequately integrated into the care of this patient group. Highlighting patients developing or having established nutritional deficits is problematic. A bedside traffic light system under evaluation may improve awareness by MDT members.