Improving Nutritional Support of Burn Service Patients by Increasing the Number of Days When 100% of Prescribed Formula Is Given

Abstract

The authors sought to increase the number of days when burn service patients receive 100% of prescribed enteral nutrition. The authors first performed a retrospective review of 37 patients (group 1) receiving enteral nutrition. The authors then created and implemented a nurse-directed feeding algorithm, placing patients into three age groups addressing maximum hourly infusion rates, high residual limits, initiating feeding, refeeding residuals, and replacing formula. The authors then performed a prospective review of 37 patients (group 2) fed utilizing the new algorithm. The amount of prescribed, infused, discarded, and missed feeds were recorded, as well as admitting diagnosis, age, gender, length of stay, ventilator days, infections, and mortality. All patients in group 1 (n = 37) received 100% of feeds 59.9% of prescribed days vs 76.5% in group 2 (n = 37; P = .003). Burn patients in group 1 (n = 26) received 100% of feeds 61.6% of prescribed days vs 85.4% in group 2 (n = 21; P < .001). The mean amount of hours tube feeds were held for surgery, procedures, clogged or dislodged tubes, in both historical control and the group using the restorative algorithm were the same. While there was a significant difference in burn size between groups (6.24 vs 18.39%, P = .01), there were no statistically significant differences in length of stay, ventilator days, or mortality. Implementation of a nurse-directed feeding algorithm improved delivery of enteral nutrition for all burn service patients, increasing the number of days when 100% of prescribed enteral nutrition is given.

Interrupted Nutrition Support in Patients With Burn Injuries: A Single-Centre Observational Study

“…There is also an opportunity to examine clinical practice and policies related to continuing EN feeding for tracheostomy and ventilated patients as recommended by Rousseau and others. 18,20 Limitations First, the cross-sectional nature of this study and the small sample size limit the extent to which we can generalize findings. Second, due to technical issues with the metabolic cart, it was not always available to measure caloric needs, and, in some cases, the predictive equation alone was used to establish caloric requirements.…”

“…There is also an opportunity to examine clinical practice and policies related to continuing EN feeding for tracheostomy and ventilated patients as recommended by Rousseau and others. 18,20…”

“…7 Also, advances have been made by implementing nursing-specific algorithms on maximizing feeds. 20 The findings of this study have been used to change local clinical practice to minimize caloric loss and compensate for predictable clinical events. Since the evaluation of these data, our institution has implemented a modified PEP uP protocol in order to compensate for EN interruptions over a 24- to 72-hour period.…”

Safety and Tolerance of Intraoperative Enteral Nutrition Support in Pediatric Burn Patients

“…The mean duration of EN interruptions was 8.9 ± 3 h/d . Conrad found in his study of burn patients that 100% of estimated nutrient needs were only met on an average of 59.9% of days when EN support was ordered . Nutrition and clinical outcomes can be compromised with prolonged inadequate nutrition support .…”

“…10 Conrad found in his study of burn patients that 100% of estimated nutrient needs were only met on an average of 59.9% of days when EN support was ordered. 29 Nutrition and clinical outcomes can be compromised with prolonged inadequate nutrition support. 12,13 Rimdeika et al demonstrated in adult burn patients who received <30 kcal/kg of nutrition/d a significantly higher association with increased complication rates, duration of treatment, and mortality (P < 0.05; P = 0.01; P < 0.01).…”