Author Response

Abstract

I n response to the letter to the editor about our article "Development and Implementation of an Audit Tool for Quality Control of Parenteral Nutrition," we would like to comment on some of the questions asked and points made in the letter.It is a pleasure to receive comments about our article as well as to see other teams developing tools for nutrition quality control. As we concluded in our article, "The definition of quality criteria and their standards is an efficient method of providing a qualitative and quantitative analysis of the clinical care of patients on parenteral nutrition" 1 and, most important, of improving the nutrition care of patients.As the authors affirm, a quality indicator must comply with the characteristics that they described in their letter: it must be realistic, valid, clear, and inexpensive. Nevertheless, we think that these observations do not correspond with the content and intention of our article 1 : "to describe the development of a [our] quality control methodology."As we affirm in the last sentence of our article, "The criteria proposed have been selected and elaborated depending on literature, on our work, and on the results obtained throughout the years." 1 The audit tool has allowed us to: (1) know the current level of quality measured by internal quality criteria standards, (2) establish corrective policies and future issues to be improved or adapted to the newest international recommendations, and (3) increase the standard requirements needed to reach the desirable quality. We concur with the authors that this is a good path to improvement, and it is important to establish initiatives in this respect.We reaffirm that even if all criteria are based on the available literature, our target is not to establish a universal, "validated" audit tool that can be used in other fields of medicine (in fact, it is not indicated in this way in our article). In our hospital, the described method has been efficient and effective to reach our target: improve nutrition care.We agree with the authors that nutrition interventions must be made by a multidisciplinary team; nevertheless, and as we indicate in the text, 1 when the quality control program was implemented, there was not a multidisciplinary nutrition team in our hospital, and "due to the lack of it at that time, the Pharmacy Service developed, by consensus with other medical services, a protocol of clinical care of PN." At that point, the pharmacist was responsible for nutrition assessments.Finally, quantifying the percentage of nutrition assessments completed in a set time is a difficult task (criterion 5). It is necessary to consider different criteria and assess the importance of the most relevant ones. The design of the nutrition plan does not change significantly with the way this criterion is defined, and the corrective goal is to complete nutrition assessments for all patients, measuring all the indicated parameters. With this as the intention, the established standard was 100% to stimulate us to always conduct this assessmen...