Aplicação da ferramenta AGREE-II para avaliação das diretrizes clínicas de protocolos de terapia nutricional enteral na prática profissional de nutricionistas

Abstract

RATIONALE: In the healthcare sector, protocols are routinely used to standardize and standardize patient care procedures and information, contributing to safer and more effective decision-making. This requires the protocol to help capture and store data, enabling control, analysis and monitoring of the patient. In the context of Enteral Nutritional Therapy (ENT), protocols are used to guide the professional practice of nutritionists in multi-professional teams, by presenting routines and pointing out ways to improve care processes. OBJECTIVE: To assess the quality of the clinical guidelines of the ENT protocol for the professional practice of nutritionists at the Getúlio Vargas University Hospital of the Federal University of Amazonas (HUGV/UFAM). METHOD: In order to meet the proposed objective, the evaluation was carried out using the adapted AGREE-II tool, making it possible to assess the quality, methodological rigor and transparency with which the ENT protocol was developed. The AGREE-II tool evaluates a set of 6 domains: Scope and purpose; Stakeholder involvement; Rigor of development; Clarity of presentation; Applicability; and Editorial independence. To apply the AGREE-II tool, four trained nutritionist evaluators used the structured questionnaire with twenty-three questions to evaluate the ENT protocol. In a second stage, an analysis of documents and available scientific literature was carried out in order to corroborate the data found with the application of the tool. Based on the results of the research, an e-book was produced on the application of the AGREE-II tool for evaluating ENT protocols. The content of the e-book was organized based on a survey of information published in the literature on the AGREE-II tool and its application in protocols in the area of Clinical Nutrition and Health, by searching guides, scientific articles, government documents, documents from health associations and similar materials. RESULTS: In the evaluation of the ENT protocol, it was verified that domains 3 “Rigour in development”, 5 “Applicability” and 6 “Editorial independence” received lower scores. On the other hand, domain 4 “Clarity of Presentation” received the highest score. The overall assessment of the ENT protocol clinical guidelines was 66.7%. The development of the e-book resulted in the writing of four chapters on the following topics: Professional role of the nutritionist in the standardisation of enteral nutrition therapy protocols; The AGREE-II tool; Domains of the AGREE-II tool; Applying the AGREE-II tool in the area of Clinical Nutrition. CONCLUSION: Using the AGREE-II tool to evaluate the ENT protocol used at the HUGV/UFAM, 66.7% of the overall evaluation of the clinical guidelines was adequate, showing that the tool is capable of contributing to systematizing and measuring the quality of these documents, making it possible to identify points of weakness that can be corrected in order to improve the patient's nutritional care. However, this requires the engagement of nutritionists from the multi-professional team in the evaluation and revision of the ENT protocol.