This study found that nursing experience and level of education do not significantly affect the readiness of nurses to adopt a feeding protocol. Medical and nursing teams should not shy away from introducing a new protocol although their nurses have little experience or prior knowledge of that protocol. Future studies to investigate the impact of tailoring of educational needs before introduction of a new protocol are necessary to study the overall effectiveness of this teaching before introducing a new protocol in the ICU.

Background: To determine effectiveness of a nurse-led, volume-based feeding protocol in our pediatric intensive care unit (PICU), we evaluated patients' nutrition adequacy pre-and post-protocol implementation. Methods: We conducted an observational study of patients admitted for more than three days in the PICU during pre-and post-feeding protocol periods. We recorded energy and protein intake and feed interruptions in patients started on enteral nutrition over the first seven days of admission. We excluded patients with septic shock requiring more than two inotropes, post-cardiac and post-gastrointestinal surgeries. To determine nutrition adequacy, actual energy and protein intakes were compared with calculated requirements, expressed as percentages. Results: We had a total of 40 patients (20 in the pre-and post-protocol groups, respectively) with median age of 9.4 (interquartile range (IQR) 2.8, 57) months. Median time to feed initiation was similar between groups (20.0 (IQR 17.0, 37.5) vs. 21.5 (IQR 10.5, 27.0) hours, p = 0.516). There was no difference in median energy (55 (IQR 12, 102) vs. 59 (IQR 25, 85) %, p = 0.645) and protein intake (53 (IQR 16, 124) vs. 73 (IQR 22, 137) %, p = 0.069) over the seven-day period between groups; the proportion of patients meeting their energy (10 vs. 35%, p = 0.127) and protein goal (15 vs. 30%, p = 0.451) by day three also did not differ significantly pre-and post-protocol implementation. The most common reasons for feed interruption were intubation/extubation and radiological procedures. Conclusion: Our current feeding protocol did not improve nutrient adequacy. The effectiveness of a more aggressive protocol in units where enteral nutrition is initiated within 24 hours should be investigated.

Learning Objectives: Patterns of communication with physicians are important determinants of parental satisfaction with their child's care in the intensive care unit (ICU). ICU physicians communicate with families in multiple formats including at the bedside, during family-centered rounds and during formal family conferences. We hypothesize that differences exist in the communication formats preferred by English and Spanish-speaking families. Our purpose is to describe families' communication experiences and identify potential disparities. Methods: We conducted a prospective, cross-sectional study with English and Spanishspeaking families of children admitted to the pediatric or cardiac ICU at a pediatric tertiary care hospital. Families completed a survey regarding their preferences for communication with ICU physicians. The study was approved by the institutional review board. Results: 134 families were enrolled, including 33 (25%) Spanish-speaking families. Overall, Spanish-speaking parents were more likely to be younger (30 vs. 36 years, p=0.007), reported less educational achievement (p<0.001), and had Medicaid insurance (p<0.001). Most families (60%), both English and Spanish-speaking, reported receiving information from physicians in their preferred setting, which was most commonly during rounds or at the bedside. English-speaking families were more likely to have been invited to participate on rounds (p<0.001), understood material discussed on rounds (p<0.001), reported that the nurse spent enough time speaking with them (p=0.006), and that they were able to rely on the nurse to explain key aspects of medical care (p=0.009). 64% of Spanish-speaking families reported interpreter use on arrival to the ICU; but only 21% of families who would prefer an interpreter reported having one available for communication with the medical team throughout the ICU stay. Conclusions: Most families receive communication in the ICU in their preferred setting. Spanish-speaking families are not as supported during rounds and communication for these families could be improved with ready availability of in-person interpreters.