RESUMEN
The nutritional support team must justify its role by proving that it provides an adequate quality control and supervises the administration of the nutritional support to avoid its inappropriate use. The measures based on the process reported on the improvement opportunities while those based on the results allow an evaluation of the quality. The objective of this study is to present the results of a systematic search for improvement opportunities in two fundamental activities of the nutritional support team: the evaluation of the patient needs, and the adequation of the caloric supply to these needs. The data corresponding to nutritional support and nutritional assessment of 217 patients who initiated central parenteral nutrition during the perioperative surgery period for a laparotomy were registered between January of 1996 and June of 1997. These data were used to calculate 8 selected quality indicators to report on the quality of the activities subject to the evaluation. Moreover, the initial and final values of the nutritional assessment parameters of a sub-group of patients were compared with the aim of obtaining a measure of the result of parenteral nutrition. The final average levels of albumin, prealbumin, transferin, and the Nutritional Prognostic Index were significantly better than the initial data in the subgroup in which these data were available. The analysis of the process indicators allowed the detection of the need to reduce the caloric supply in relation to the protein supply and to promote the use of programs with a caloric supply that was better adjusted to the BMI and/or the patients' weight. It was also shown that it is necessary to increase the number of patients assessed from a nutritional point of view at the beginning and at the end of parenteral nutrition.