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

INFANTS; MORTALITY; NEUROLOGIC examination; NURSES; MALNUTRITION; FOOD consumption; HUMAN services programs; CRITICALLY ill; PATIENTS; EDUCATION; RESEARCH funding; HUMANITY; NUTRITIONAL requirements; NEUROSCIENCES; INFECTION; DESCRIPTIVE statistics; ENTERAL feeding; PRE-tests & post-tests; CAREGIVERS; INTENSIVE care units; NUTRITIONAL status; ATTITUDES of medical personnel; ARTIFICIAL respiration; ISCHEMIC stroke; SEIZURES (Medicine); QUALITY assurance; LENGTH of stay in hospitals; PHYSICIANS; COMPARATIVE studies; NUTRITION; CRITICAL care medicine; DEGLUTITION disorders; MEDICAL care costs; HEALTH care teams; HEMORRHAGE

Background: Iatrogenic 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 Problem: This project was conducted in an 8-bed neuroscience intensive care unit in which up to 41% of patients who required enteral feeding were underfed. Methods: This 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. Results: During 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. Conclusions: Using a volume-based feeding protocol with supplemental staff education resulted in improved delivery of prescribed enteral feeding. [ABSTRACT FROM AUTHOR]