Análise da assistência multidisciplinar ao paciente em uso da terapia nutricional enteral na unidade de terapia intensiva adulto: estudo retrospectivo

Abstract

Objective: To analyze the multidisciplinary care of patients hospitalized and receiving Enteral Nutrition Therapy via nasoenteric tube in the Adult Intensive Care Unit of a University Hospital, through the records of physical and electronic medical charts. Material and Method: This is a quantitative, retrospective, descriptive study in terms of objectives and documentary in terms of procedures, in which physical and electronic medical charts of patients who were admitted to the Adult ICU of the University Hospital were evaluated. This research was approved by the Ethics Committee for Research with Human Beings at UFSCar, CAAE 76566623.5.0000.5504. Results: From January 1, 2023, to March 31, 2024, a total of 48 patients were hospitalized in the Adult ICU of the University Hospital and required Enteral Nutrition via nasoenteric tube. The high mortality rate of the cases evaluated is noteworthy, with 35 (72.92%) patients progressing to death. When analyzing the performance of one or more nasoenteric tube placements per patient, it was observed that in most cases (n = 30 - 62.50%), only one placement was performed. It was noted that 20 (41.67%) medical charts recorded the indication for Enteral Nutrition in the Medical Progress Notes. When analyzing the total number of tube placements performed (n = 84 - 100%), only 20 (23.81%) had requests for X-rays recorded to confirm tube positioning after insertion. Comparatively, the request for X-rays by medical professionals was found in 81 (96.43%) nasoenteric tube placements in the nursing team's notes. Regarding the placement of nasoenteric tubes by nurses, 75 (89.29%) were recorded; only 8 (9.52%) had documentation of the type and size of the nasoenteric tube used, and 13 (15.48%) recorded tolerance or complications during placement. Concerning the documentation of the insertion nostril and external measurement, 51 (60.71%) contained this data; 18 (21.43%) conducted bedside position confirmation testing via auscultation, 46 (95.83%) documented the prescription of care for the nasoenteric tube, and only 49 (58.33%) recorded confirmation of X-ray completion, including the name and professional category of the person who performed it. In 34 (70.83%) cases, there was documentation of the initiation of enteral feeding with the system opening time, infusion rate, and responsible party, while this information was not found in 11 (22.92%) charts. During the ICU stay, 40 incidents related to nasoenteric tubes were identified, most of which involved accidental externalization (25 - 62.5%). No records of these incidents were found in the hospital's internal notification system. Conclusions: Healthcare professionals' records are essential for documenting interventions and care for hospitalized patients and are necessary for identifying areas for improvement in care processes to avoid errors and prevent adverse events.