Nutrition Support Protocols and Their Influence on the Delivery of Enteral Nutrition: A Systematic Review

Stewart, Melissa Lottes

doi:10.1111/wvn.12036

Cited by 22 publications

(9 citation statements)

References 27 publications

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“…The use of evidence‐based feeding protocols for the commencement and escalation of enteral nutrition have been well researched in the critical care setting, whereas the use of a protocol to guide the transition from EN to ON in the acute setting is novel. Findings of this study demonstrated similar improvements in consistency of nutrition delivery to previous studies in the critical care setting . Prior to implementation of the TFP, feeding practices were observed to be inconsistent with various forms of TF being administered, and a high proportion of patients ceasing EN without dietetic intervention.…”

Section: Discussionsupporting

confidence: 72%

Improving nutrition care for neurosurgery patients through a nurse‐led transition feeding protocol

Dux

Lim

Jeffree

et al. 2019

Nutrition & Dietetics

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Aim Neurosurgical patients often transition from enteral nutrition (EN) to oral nutrition (ON) as they recover. Implementing a nurse‐led feeding protocol to guide this transition may improve consistency of nutrition care and dietitian workload efficiency. This pragmatic study aimed to evaluate the effect of such a protocol on these outcomes and on nurses’ nutrition care attitudes, practices and knowledge. Methods Data were collected retrospectively for 1 year pre‐ and prospectively for 1 year post‐implementation of the transition feeding protocol (TFP). Participants who transitioned from EN to ON were included in the study. Post‐implementation nurses in the neurosurgery ward were invited to complete a self‐administered questionnaire to investigate attitudes, practices and knowledge. Results One hundred and thirteen participants, 55 pre‐ and 58 post‐implementation, took part in the study. Significantly more patients received transition feeding (TF) post‐implementation (58% vs 93%, P < 0.001), there was a statistically significant improvement in the commencement of TF (0 vs 1 day after ON clearance; P = 0.029), and all patients consumed adequate oral intake 1‐week post‐EN cessation (92.3% vs 100%, P = 0.078). There was no difference in dietetic occasions of service post‐implementation (2 vs 1.5; P = 0.204). A 38% survey response rate from nursing staff (n = 15) was achieved. More nurses were found to be initiating TF (P < 0.001) and a majority reported a perceived increase in knowledge and confidence in providing nutrition support. Conclusions A TFP can optimise the transition from EN to ON by improving consistency and commencement of TF and nurses’ confidence and knowledge in overall nutrition care.

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Section: Discussionsupporting

confidence: 72%

Improving nutrition care for neurosurgery patients through a nurse‐led transition feeding protocol

Dux

Lim

Jeffree

et al. 2019

Nutrition & Dietetics

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“…Regardless of strategy, ICU EN feeding protocols help to promote compliance with clinical practice guidelines–directed nutrition practices and lead to optimization of nutrition therapy as a whole 28 , 29 . A review of 19 studies demonstrated that protocol implementation has a positive impact on the number of patients receiving nutrition therapy, the optimization of volume intake, the time to initiation of nutrition therapy, and the number of days with nutrition therapy and yields better reported outcomes related to feeding optimization 30 …”

Section: Discussionmentioning

confidence: 99%

Process‐Related Barriers to Optimizing Enteral Nutrition in a Tertiary Medical Intensive Care Unit

2015

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Purpose Enteral nutrition (EN) is the preferred route of nutrient delivery in critically ill patients. Research has consistently described an incomplete delivery of EN in critically ill patients. The purpose of this study was to investigate barriers to reach and maintain >90% prescribed EN amongst critically ill MICU patients. Methods We performed a retrospective cohort quality improvement study of adult patients ≥18 years of age admitted to a tertiary MICU and referred for EN from October 1–December 31, 2013. We excluded patients who received intermittent or bolus feeding. Demographic, clinical, and nutrition data were collected. Potential barriers to EN were categorized a priori. Results Seventy-eight patients receiving a total of 344 days of EN were included in the study. EN was initiated at a median of 32 hours (IQR 18.5–75 hours) after ICU admission. Initiation and advancement of EN was identified as the most common reason for <90% prescribed intake. Top 5 interruption reasons were (1) extubation (2) fasting for bedside procedure (3) loss of enteral access and (4) gastric residual volume 0–499 mL and (5) radiology suite procedure Conclusions Sub-optimal EN volume delivery continues to be an issue in critically ill patients. Our study identified initiation and advancement of EN as the most common reason for sub-optimal EN volume delivery. Variation in practice was also noted within several categories and multiple reversible barriers to optimal EN delivery were identified. These data can serve as the impetus to modify practice models and workflow to optimize EN delivery amongst critically ill patients.

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“…Combating this double burden of malnutrition (DBM) has become a significant global health challenge in many healthcare settings [36]. DBM is characterized by the coexistence of undernutrition along with obesity or diet-related noncommunicable disease and is associated with poor outcomes and increased cost of hospitalization [20, 36]. Literature has shown that nutritional therapy, both enteral and parenteral, is the most cost-effective intervention in managing malnutrition in critical illness before ICU admission and after discharge, including the rehabilitation period [37–39].…”

Section: Discussionmentioning

confidence: 99%

“…However, despite the highlighted benefits, a number of barriers to effective implementation of nutritional therapy guidelines exist [18]. In many clinical settings, decisions made by healthcare providers involved in the nutrition care of critically ill patients are found not to be based on scientific evidence, leading to varied nutritional practices in many ICUs, even within a single hospital [19, 20].…”

Section: Introductionmentioning

confidence: 99%

Evidence on nutritional therapy practice guidelines and implementation in adult critically ill patients: a scoping review protocol

Mooi

Ncama

2019

Syst Rev

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Background: Nutritional therapy practice guidelines are designed to improve nutritional practices and thus the delivery of nutritional therapy in critically ill patients. However, they are not implemented despite the strong recommendation of nutritional therapy in the management of critical illness. The aim of this study is to map evidence on nutritional therapy guidelines and their implementation in critically ill adult patients. Methods: Two independent reviewers will conduct a search of published scholarly and gray literature on the implementation of nutritional therapy guidelines in critically ill adults using Arksey and O'Malley's scoping review framework. The search of studies will be conducted from databases such as PubMed, Google Scholar and EBSCOhost databases,

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Nutrition Support Protocols and Their Influence on the Delivery of Enteral Nutrition: A Systematic Review

Cited by 22 publications

References 27 publications

Improving nutrition care for neurosurgery patients through a nurse‐led transition feeding protocol

Improving nutrition care for neurosurgery patients through a nurse‐led transition feeding protocol

Process‐Related Barriers to Optimizing Enteral Nutrition in a Tertiary Medical Intensive Care Unit

Evidence on nutritional therapy practice guidelines and implementation in adult critically ill patients: a scoping review protocol

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