PURPOSE: Inadequate caloric replacement in critically ill patients is a known problem in most intensive care units. This suboptimal caloric supply is multifactorial; ranging between delay initiation of enteral feeding to lack of consistent approach toward defining and managing high gastric residuals among nurses and physicians.We introduced a nurse driven protocol for enteral feeding for consistent and uniform feeding practise.
METHODS: This prospective study consists of 2 phases: before and after implementation of enteral feeding protocol. The primary end point was caloric intake after 48 hours of enteral feed and the secondary end points were timing of initiating enteral feeding, residual volumes, unnecessary interruptions and descalation. Random retrospective review of 50 patient's charts was done to collect the above information. The feeding protocol, with caloric requirement targets, instructions to start feeding within 48 hours, unless specified not to feed by the physician, directions to manage response to high residual, when to stop feeding, at what rate resume feeding was implemented. Post protocol data from first 50 patients was collected and compared with the data before the protocol was introduced.
RESULTS: The random chart review of 50 patients before implementation of protocol showed, 50% (25/50) of the patients had their feeding started after 48 hours of ICU admission, only 44% (28/50) reached caloric requirements of 80% and above, after 48 hours of enteral feed. The incidence of unnecessary interruptions and descalation was up to 64% (32/50). The same data obtained after implementation of protocol showed that 94% (3/50) of the patients had their feed started before 48 hours of ICU admission, 90% (5/50) reached the caloric requirement of 80% and above within 48 hours of starting feeding. The incidence of unnecessary interruptions and descalation was only 22% (11/50).
CONCLUSION: The implementation of Nurse driven feeding protocol not only markedly improved the caloric intake of critically ill patients, but also had a significant impact on the timing and on unnecessary interruptions and descalation.
CLINICAL IMPLICATIONS: To improve nutritional support of critically ill patients.
DISCLOSURE: Raees Ahmed, No Financial Disclosure Information; No Product/Research Disclosure Information