• Hannah E Landgrave.
• Hannah E. Landgrave is an assistant professor at the Moffett and Sanders School of Nursing, Samford University, Birmingham, Alabama, and a critical care nurse in the medical intensive care unit, UAB Hospital, Birmingham.
• Crit Care Nurse. 2024 Feb 1; 44 (1): 344434-44.

BackgroundRoutine gastric residual volume monitoring remains common in nursing practice. However, current evidence supports using a focused nursing assessment to identify signs and symptoms of enteral feeding intolerance such as abdominal pain, abdominal distension, and vomiting.Local ProblemAt the author's institution, nurses and other clinicians began reporting inconsistencies in gastric residual volume monitoring along with frequent interruptions in the delivery of enteral nutrition.InterventionsThe quality improvement project included patients in the medical intensive care unit receiving enteral nutrition. Gastric residual volume monitoring was eliminated. Instead, enteral nutrition was suspended on the basis of signs and symptoms of enteral feeding intolerance. Multimodal education was provided to nurses, nurse practitioners, and physicians caring for these patients. Formative evaluation occurred via staff rounds, summative evaluation occurred through a staff survey, and nutritional adequacy was evaluated by tracking patient weight.ResultsThe 6-week project included 37 patients on the medical intensive care unit service. Of these patients, 28 gained weight; the mean change in weight was +6.2%. The practice change was well perceived by staff and is now an established part of care for any patient receiving enteral feedings at the study hospital.ConclusionsThe deimplementation of routine gastric residual volume monitoring is supported by evidence. Use of a focused gastrointestinal nursing assessment to identify enteral feeding intolerance is safe, feasible, and effective and improves nutrition delivery and nurses' workflow.©2024 American Association of Critical-Care Nurses.

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