14 Do Calorie Counts Alter Care or Outcomes in Burn Patients?

Abstract

Abstract Introduction Calorie counts are often used as a monitoring tool for burn nutrition and require accurate documentation by staff for the nutritionist to properly evaluate and treat the patient. The objective of this project was to determine if completion of calorie counts positively impacts patient outcomes. Methods A quality improvement project was conducted on adult burn patients at a large academic medical center from June 2018 to March 2019. All burn patients with calorie count orders and an admission weight were included. The total number of meal trays with completed calorie count documentation was calculated on a weekly basis, generating a total weekly calorie count compliance rate (CCCR). Data collected included weight change from admission to discharge, standard nutrition labs, and if nutritional interventions were changed. Results A total of 76 adult burn patients with a documented admission weight were included. The average total body surface area (TBSA) burn injury was 10.9%. Average length of stay was 1.3 days/ %TBSA. Of the 9.2% of patients with admission and discharge weights, 14% had increased discharge weight (mean CCCR 43%) and 86% had a decrease in weight (mean CCCR 48%). Weekly total protein levels were obtained in 24 patients with 46% having decreased total protein levels (0.1 to 1.1 g/dL) and a mean CCCR of 74.4%. Eight percent had no change in protein levels with a mean CCCR of 74.3% and 46% had increased total protein levels (0.1 and 0.7 g/dL) with a mean CCCR of 70%. Weekly albumin levels were obtained in 25 patients. Fifty-two percent had decreased albumin levels (0.1 to 0.9 g/dL) with a mean CCCR of 72.1%. Twenty percent had no change in albumin level, with a mean CCCR of 75.1% and 28% of patients had increased albumin levels (0.1 to 0.6 g/dL) with a mean CCCR of 69%. Weekly prealbumin serum levels were obtained in 27 patients. Fifty-six percent had decreased levels (1 to 19 mg/dL) with a mean CCCR of 74.1%. Four percent had no change in serum prealbumin, with a mean CCCR of 69%, and 41% had increased prealbumin levels (1 to 21 mg/dL) with a mean CCCR of 68%. Nutritional therapy was altered in 6% of patients by addition of oral supplementation, dietary modifications, or initiation of tube feeding. Conclusions A very small number of patients on calorie counts had any change in nutritional therapy and calorie count compliance showed no relationship with nutrition labs. However, calorie counts are labor-intensive for nursing staff. Further research should be conducted to identify which patients would benefit from daily calorie counts in the burn patient. Applicability of Research to Practice Use of evidence-based outcome measures can drive clinical practice.