Towards Implementation of the Pediatric Integrated Nutrition Pathway for Acute Care Pathway (P-INPAC) - Pilot Study
试验速览
- 阶段
- 不适用
- 状态
- 进行中（未招募）
- 入组人数
- 600
- 试验地点
- 6
- 主要终点
- Baseline nutrition risk screening using STRONGkids or PNST
研究概览
简要总结
The framework for Pediatric Integrated Nutrition Pathway for Acute Care (P-INPAC) was developed by the Canadian Malnutrition Task Force (CMTF); however, it has not been implemented in a research setting. The framework by CMTF for Integrated Nutrition Pathway for Acute Care (INPAC) in adults was also implemented in the "More-2-Eat" project which led to development of best practices in nutritional culture of the hospitals. Therefore, we intend to undertake this feasibility project at 3-sites to train staff and evaluate the implementation of P-INPAC components as part of routine healthcare procedure.
详细描述
The P-INPAC pilot study will be a 3-phase multi-center research study in hospitalized children, conducted at The Hospital for Sick Children, Toronto, and two other Canadian pediatric centres: Centre hospitalier universitaire Sainte-Justine, Montreal, Quebec and McMaster Children's Hospital, Hamilton, Ontario. P-INPAC is an algorithm which helps to identify, assess, and treat children with malnutrition.
In the first phase of the study, we will perform an audit of health records of all hospitalized patients at one selected study ward, one day of every other week for 8 weeks, at each of the 3 study sites to track their routine nutrition care. We anticipate auditing 80-100 patients/site in this cycle (total 240-300 patients). In addition, ≈12- 20 patients/ site (≈ 60 in total) who consent to detailed malnutrition screening and assessment would also be identified, assessed, and followed up one month after discharge. In addition, a questionnaire assessing the malnutrition knowledge, attitude, and self-perceived practices (KAP) amongst healthcare professionals will be conducted with staff, including trainees, at each site's study ward. Further, the workload of the study ward's Registered Dietitian (RD) will be assessed for 3 days.
In the second phase of the study, the health care team from each site's study ward will be trained by the site implementation research team about the P-INPAC, and how to administer nutritional screening and perform nutritional assessments, which is the Subjective Global Nutrition Assessment (SGNA).
Finally, in the third phase, we will monitor and evaluate the implementation of the first 2 steps of the P-INPAC (screening & assessment) over a period of 4 months assessing the acceptability, adoption, and coverage of improved nutrition care practices on the same pediatric study wards. We anticipate auditing 160-200 patients/site in this cycle (total 480-600 patients). In addition, detailed patient level data collection will take place in a selected group of consented patients, ≈24-40 patients per site from the 3 sites (≈120 in total). We would also follow-up with these patients a month after discharge.
Healthcare providers will be invited to answer the KAP questionnaire post-implementation version. We will compare responses from phase 1 with phase 3 (pre-/ post-follow up). And, the workload of the ward RD will be assessed again over 3 days.
研究设计
- 研究类型
- Observational
- 观察模型
- Other
- 时间视角
- Prospective
入排标准
- 年龄范围
- 30 Days 至 18 Years（Child, Adult）
- 性别
- All
- 接受健康志愿者
- 是
入选标准
- •Phase 1 and Phase 3 - Audited patient group inclusion Criteria:
- •≥ 30 days of age and less than18 years of age on day of assessment
- •Anticipated Length of hospital stay ≥24 hours from day of assessment
- •Phase 1 & Phase 3 Detailed patient group inclusion Criteria:
- •Admitted to either a general medical or surgical ward
- •≥ 30 days of age and less than 18 years of age on day of assessment
- •Anticipated Length of stay ≥ 24 hours from day of assessment
- •Speak English (or French at Quebec site) or have a family proxy available at the meal to provide information if first language of patient is not English (or French at Quebec site)
- •Patient/ caregiver provides written consent to participate
排除标准
- •a. Patients with eating disorder, somatization disorders, ARFID, FORM 1 etc. where the study interaction might interfere with the messaging or therapeutic plan as set out by the responsible team.
- •Phase 1 and 3 for Health Care Providers inclusion criteria:
- •Implied consent to participate by completing the KAP questionnaire
- •Providing clinical service for the select ward
结局指标
主要结局
Baseline nutrition risk screening using STRONGkids or PNST
时间窗: 2-month period (phase 1)
Determine routine standard nutritional care practices related to nutrition risk screening in hospitalized children during phase 1 of study using a validated tool, such as, STRONGkids or PNST.
Baseline nutrition risk screening using weight
时间窗: 2-month period (phase 1)
Determine routine standard nutritional care practices related to nutrition risk screening in hospitalized children during phase 1 of study using routine anthropometrics - weight
Baseline nutrition risk screening using height or length
时间窗: 2-month period (phase 1)
Determine routine standard nutritional care practices related to nutrition risk screening in hospitalized children during phase 1 of study using routine anthropometrics - height or length in children under 2 years of age
Baseline nutrition risk screening using head circumference
时间窗: 2-month period (phase 1)
Determine routine standard nutritional care practices related to nutrition risk screening in hospitalized children during phase 1 of study using routine anthropometrics - head circumference in children under 2 years of age
Determine baseline knowledge among healthcare providers using the KAP questionnaire
时间窗: 2-month period (phase 1)
Determine baseline knowledge among healthcare providers on recognizing malnutrition and its management in hospitalized children, including perceived barriers and practices, using the KAP questionnaire
Determine changes in knowledge among healthcare providers using the KAP questionnaire
时间窗: 4-month period (phase 3)
Determine changes in knowledge among healthcare providers on recognizing malnutrition and its management in hospitalized children in Phase 3, including perceived barriers and practices, using the KAP questionnaire after training was completed in phase 2
Determine success with training and feasibility of nutrition risk screening in hospitalized children using STRONGkids and PNST
时间窗: 4-month period (phase 3)
Determine success with training and feasibility of implementing the P-INPAC framework by assessing changes in standard nutritional care practices related to nutrition risk screening in hospitalized children during phase 3 of study using a validated tool, such as, STRONGkids and PNST
Determine success with training and feasibility of nutrition risk screening in hospitalized children using weight
时间窗: 4-month period (phase 3)
Determine success with training and feasibility of implementing the P-INPAC framework by assessing changes in standard nutritional care practices related to nutrition risk screening in hospitalized children during phase 3 of study using routine anthropometrics - weight
Determine success with training and feasibility of nutrition risk screening in hospitalized children using height/ length
时间窗: 4-month period (phase 3)
Determine success with training and feasibility of implementing the P-INPAC framework by assessing changes in standard nutritional care practices related to nutrition risk screening in hospitalized children during phase 3 of study using routine anthropometrics - height or length in children under 2 years of age
Determine success with training and feasibility of nutrition risk screening in hospitalized children using head circumference
时间窗: 4-month period (phase 3)
Determine success with training and feasibility of implementing the P-INPAC framework by assessing changes in standard nutritional care practices related to nutrition risk screening in hospitalized children during phase 3 of study using routine anthropometrics - head circumference in children under 2 years of age
次要结局
未报告次要终点
研究者
Jessie Hulst
Staff Physician
The Hospital for Sick Children