• Critical care nurse · Jun 2024

    Increasing the Volume of Delivered Enteral Feeds Using a Volume-Based Feeding Protocol in a Neuroscience Intensive Care Unit.

    • L Douglas Smith, Haley Hoy, and Sage Whitmore.
    • L. Douglas Smith Jr is the lead critical care advanced practice provider and critical care nurse practitioner, HCA Healthcare Intensivist Services, HCA Healthcare TriStar Centennial Medical Center, Nashville, Tennessee, and a faculty member at Vanderbilt University School of Nursing, Nashville.
    • Crit Care Nurse. 2024 Jun 1; 44 (3): 546454-64.

    BackgroundIatrogenic malnutrition is a significant burden to patients, clinicians, and health care systems. Compared with well-nourished patients, underfed patients (those who receive less than 80% of their daily energy requirement) have more adverse outcomes related to nutritional status. Volume-based protocols allow for catch-up titrations, are consistently superior to rate-based protocols, and can be implemented in most settings.Local ProblemThis project was conducted in an 8-bed neuroscience intensive care unit in which up to 41% of patients who required enteral feeding were underfed.MethodsThis quality improvement clinical practice change project used a before-and-after design to evaluate (1) the effect of implementing a volume-based feeding protocol on the delivery of enteral feeds and (2) the effect of a nutrition-based project on staff members' attitudes regarding nutrition in critical care. The effectiveness of a volume-based feeding titration protocol was compared with that of a rate-based feeding protocol for achieving delivery of at least 80% of prescribed nutrition per 24-hour period. Staff members' attitudes were assessed using a survey before and after the project.ResultsDuring 241 enteral feeding days (n = 40 patients), the percentage of delivered enteral feeding volume and the percentage of days patients received at least 80% of the prescribed volume increased after volume-based feeding was implemented. After project implementation, 74 staff members reported increased emphasis on nutrition delivery in their practice and a higher level of agreement that nutrition is a priority when caring for critically ill patients.ConclusionsUsing a volume-based feeding protocol with supplemental staff education resulted in improved delivery of prescribed enteral feeding.©2024 American Association of Critical-Care Nurses.

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