An Enteral Nutrition Protocol to Improve Efficiency in Achieving Nutritional Goals

Racco, Marian

doi:10.4037/ccn2012625

Cited by 12 publications

(8 citation statements)

References 6 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Ancillary orders : Routine or ancillary orders will depend on both the population and setting. These orders are based on institutional policies for care of the enterally fed patient, such as orders for HOB elevation, tube occlusion treatment, bowel management, 66 and monitoring laboratory parameters.…”

Section: Section 5 Procure Select/prepare Label and Dispense Enmentioning

confidence: 99%

“…‐ 8 Heyland et al 9 demonstrated that protocols can significantly improve nutrition practices. Racco 10 discussed development of a protocol to help overcome barriers to achieving goal rate and guide staff in areas such as holding feeding for gastric residual volume (GRV). Protocol order set included starting EN rate, energy, protein, and fluid goals as set by the nutrition support clinician, bowel management program, prokinetic agent use as indicated, and education of this order set.…”

Section: Section 6 Administration: Generalmentioning

confidence: 99%

See 1 more Smart Citation

ASPEN Safe Practices for Enteral Nutrition Therapy

Boullata

Carrera²,

Harvey

et al. 2016

J Parenter Enteral Nutr

336

531

View full text Add to dashboard Cite

Enteral nutrition (EN) is a valuable clinical intervention for patients of all ages in a variety of care settings. Along with its many outcome benefits come the potential for adverse effects. These safety issues are the result of clinical complications and of process-related errors. The latter can occur at any step from patient assessment, prescribing, and order review, to product selection, labeling, and administration. To maximize the benefits of EN while minimizing adverse events requires that a systematic approach of care be in place. This includes open communication, standardization, and incorporation of best practices into the EN process. This document provides recommendations based on the available evidence and expert consensus for safe practices, across each step of the process, for all those involved in caring for patients receiving EN.

show abstract

Section: Section 5 Procure Select/prepare Label and Dispense Enmentioning

confidence: 99%

Section: Section 6 Administration: Generalmentioning

confidence: 99%

ASPEN Safe Practices for Enteral Nutrition Therapy

Boullata

Carrera²,

Harvey

et al. 2016

J Parenter Enteral Nutr

336

531

View full text Add to dashboard Cite

show abstract

“…Change to a volume-based protocol led to significant improvement in calories and protein delivered Enteral nutrition started earlier, goal rate achieved faster, enteral delivery increased 35,36 Critical care nurses understand the complexities of care required to manage their patients. Delivery of enteral nutrition is a common, but essential treatment that requires specialized nursing knowledge and skill to prevent nutritional and clinical complications.…”

Section: Major Findingsmentioning

confidence: 99%

“…Nurses are in a unique position to take an active role in promoting the best nutritional outcomes for their patients by using and evaluating enteral nutrition protocols. 35,36 Conclusion Nutritional management of critically ill patients is no longer recognized as supportive therapy.…”

Section: Major Findingsmentioning

confidence: 99%

Nutrition Support Protocols: Enhancing Delivery of Enteral Nutrition

O’Leary-Kelley

Bawel-Brinkley

2017

Critical Care Nurse

View full text Add to dashboard Cite

NutritionIn critical care, malnutrition has a significant, negative impact on a patient's ability to respond to medical treatment. Enteral nutrition is known to counteract the metabolic changes associated with critical illness that increase the risk for serious complications and poor clinical outcomes. Inadequate delivery of nutrition support and underfeeding persist in intensive care units despite the availability of guidelines and current research for best practice. Recent studies have shown that nutrition support protocols are effective in promoting nutritional goals in a wide variety of intensive care patients. It is essential to find approaches that enhance early delivery of enteral nutrition that meets requirements and supports improved outcomes. Nurses are in a unique position to take an active role in promoting the best nutritional outcomes for their patients by using and evaluating nutrition support protocols. (Critical Care Nurse. 2017; 37[2]:e15-e23)Colleen O'Leary-Kelley, RN, PhD Karen Bawel-Brinkley, RN, PhD, CNE Nutrition Support Protocols: Enhancing Delivery of Enteral Nutrition C are of critically ill patients has become increasingly complex as a result of recent advances in technology and medicine. With this increasing complexity comes the potential for clinicians to lose sight of basic care issues such as nutritional management.1 Nutrition support has long been viewed as supportive therapy in critical care. However, with the expansion of current research revealing a more direct impact of nutrition support on patients' outcomes, nutrition is now viewed as having a more therapeutic role.2 Poor nutrition and negative energy balance combined with the catabolic stress and inflammation of acute illness and injury increase risk for complications. Complications may include increased length of stay, poor wound healing, aspiration, sepsis, and death. 3,4 In critical care, malnutrition has a significant, negative impact on a patient's ability to respond to medical treatment.5 Critical illness is associated with hypermetabolism and inflammation, which often lead to infection, organ dysfunction, and mortality. Nutrition intervention is known to counteract the metabolic changes associated with critical illness. 4 Many patients in intensive care units (ICUs) need mechanical ventilation and consequently require nutrition intervention to meet metabolic demands and supply their energy and protein needs. Current goals for nutrition support are focused on limiting catabolic response and systemic inflammation and promoting return to physiological baseline. 1 In critical illness, adequate intake of energy and protein is associated with improved clinical outcomes. As the philosophy around nutrition shifts from a supportive to a more therapeutic focus, the critical care team must use a coordinated approach to formulate decisions around nutrition support in order to provide adequate energy and protein, while avoiding the complications associated with nutrition support.1,3 Practice guidelines provide clinicians with t...

show abstract

“…First, we used expected 24-hr child urinary output based on reference values (henceforth referred to as volume-adjusted dose estimates based on expected daily urinary volume). Previous literature estimates that children have a urinary output of 1–2 mL/kg/hr ( Aust, 2012 ); we used the average output to estimate each child’s urinary output in L/day. Second, we used the mean volume of each individual’s two 24-hr composite urine samples (henceforth referred to as volume-adjusted dose estimates based on observed daily urine volume).…”

Section: Methodsmentioning

confidence: 99%

Organophosphate pesticide dose estimation from spot and 24-hr urine samples collected from children in an agricultural community

Hyland

Kogut

Gunier

et al. 2021

Environment International

View full text Add to dashboard Cite

Background: Spot urine samples are often used to assess exposure to organophosphate (OP) pesticides in place of “gold standard” 24-hr samples, which are cumbersome to collect. Assessment of non-persistent chemicals using spot urine samples may result in exposure misclassification that could bias epidemiological analyses towards the null. Few studies have examined the validity of measurements of urinary metabolites in spot samples to estimate daily OP dose or the potential implications of reliance on spot samples for risk assessments. Objective: Examine the validity of using first morning void (FMV) and random non-FMV urine samples to estimate cumulative 24-hr OP pesticide dose among children living in an agricultural region. Methods: We collected urine samples over 7 consecutive days, including two 24-hr samples, from 25 children living in an agricultural community. We used measurements of urinary dialkylphosphate (DAP) metabolites, data on nearby agricultural pesticide applications, and daily dietary intake data to estimate internal dose from exposure to a mixture of OP pesticides according to the U.S. Environmental Protection Agency Cumulative Risk Assessment guidelines. Dose estimates from volume- and creatinine-adjusted same-day FMV and non-FMV spot urine samples were compared to the “gold standard” estimates from 24-hr samples. Results: Non-FMV samples had relatively weak ability to predict 24-hr dose (R 2 = 0.09–0.38 for total DAPs) and tended to underestimate the percentage of samples exceeding regulatory guidelines. Models with FMV samples or the average of an FMV and non-FMV sample were similarly predictive of 24-hr estimates (R 2 for DAPs = 0.40–0.68 and 0.40–0.80, respectively, depending on volume adjustment method). Conclusion: Reliance on non-FMV samples for risk assessments may underestimate daily OP dose and the percentage of children with dose estimates exceeding regulatory guidelines. If 24-hr urine sample collection is infeasible, we recommend future studies prioritize the collection of FMV samples to most accurately characterize OP dose in children.

show abstract

An Enteral Nutrition Protocol to Improve Efficiency in Achieving Nutritional Goals

Cited by 12 publications

References 6 publications

ASPEN Safe Practices for Enteral Nutrition Therapy

ASPEN Safe Practices for Enteral Nutrition Therapy

Nutrition Support Protocols: Enhancing Delivery of Enteral Nutrition

Organophosphate pesticide dose estimation from spot and 24-hr urine samples collected from children in an agricultural community

Contact Info

Product

Resources

About