• Angela Bonomo, Diane Lynn Blume, Katie Davis, and Hee Jun Kim.
• Angela Bonomo is a senior professional staff nurse at the University of Pittsburgh Medical Center Shadyside, Pittsburgh, Pennsylvania. She was a senior clinical nurse I at the University of Maryland St. Joseph Medical Center, Towson, Maryland, when this article was written.
• Crit Care Nurse. 2021 Apr 1; 41 (2): 16-26.

BackgroundAt least 80% of ordered enteral nutrition should be delivered to improve outcomes in critical care patients. However, these patients typically receive 60% to 70% of ordered enteral nutrition volume. In a practice review within a 28-bed medical-surgical adult intensive care unit, patients received a median of 67.5% of ordered enteral nutrition with standard rate-based feeding. Volume-based feeding is recommended to deliver adequate enteral nutrition to critically ill patients.ObjectiveTo use a quality improvement project to increase the volume of enteral nutrition delivered in the medical-surgical intensive care unit.MethodsPercentages of target volume achieved were monitored in 73 patients. Comparisons between the rate-based and volume-based feeding groups used nonparametric quality of medians test or the χ2 test. A customized volume-based feeding protocol and order set were created according to published protocols and then implemented. Standardized education included lecture, demonstration, written material, and active personal involvement, followed by a scenario-based test to apply learning.ResultsImmediately after implementation of this practice change, delivered enteral nutrition volume increased, resulting in a median delivery of 99.8% of ordered volume (P = .003). Delivery of a mean of 98% ordered volume was sustained over the 15 months following implementation.ConclusionsImplementation of volume-based feeding optimized enteral nutrition delivery to critically ill patients in this medical-surgical intensive care unit. This success can be attributed to a comprehensive, individualized, and proactive process design and educational approach. The process can be adapted to quality improvement initiatives with other patient populations and units.©2021 American Association of Critical-Care Nurses.

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