A systematic review of feeding practices among postoperative patients: is practice in‐line with evidenced‐based guidelines?

Rattray, Megan; Roberts, Shelley; Marshall, Andrea P.; Desbrow, Ben

doi:10.1111/jhn.12486

Cited by 25 publications

(22 citation statements)

References 88 publications

(187 reference statements)

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“…In addition to timely feeding, adequate feeding, which is where patients consume ≥75% of estimated energy and protein requirements , is also important with respect to reducing the length of stay and protein‐energy malnutrition . However, recent studies indicate that many post‐surgical patients, particularly patients who have had lower gastrointestinal surgery, are not commencing feeding in timeframes outlined by evidence‐based guidelines and are not meeting their nutritional requirements in hospital . Although a combination of professional, organisational and patient‐related factors has been shown to contribute to these findings , the extent to which barriers are present at the patient level remains unclear.…”

Section: Introductionmentioning

confidence: 99%

A qualitative exploration of patients’ experiences with and perceptions of recommencing feeding after colorectal surgery

Rattray

Marshall

Desbrow

et al. 2018

J Human Nutrition Diet

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Section: Introductionmentioning

confidence: 99%

A qualitative exploration of patients’ experiences with and perceptions of recommencing feeding after colorectal surgery

Rattray

Marshall

Desbrow

et al. 2018

J Human Nutrition Diet

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“…Even in the presence of clear, evidence‐based clinical guidelines to support early post‐operative oral feeding amongst adult patients in a noncritical state of illness, adherence to those guidelines was poor with frequent delays to post‐operative feeding . Although consideration was given to the contribution of patient‐related, clinician‐driven, and organisational factors to this lack of adherence, it is clear that the existence of evidence‐based guidance has had a minimal effect on habitual clinical practice . Therefore, unsurprisingly, in the absence of clear, specific evidence‐based guidance, dietetic practice in oral nutrition support relies predominantly on clinical judgement.…”

Section: Discussionmentioning

confidence: 99%

Oral nutrition support interventions for patients who are malnourished or at risk of malnutrition: a survey of clinical practice amongst UK dietitians

Gibbs

Drey

Baldwin

2018

J Human Nutrition Diet

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Background: Guidance on choosing oral nutritional support strategies varies and the evidence for different approaches is discordant. The present study aimed to examine opinion and practice in the use of oral nutritional support amongst UK dietitians and to assess the factors that influence these clinical decisions. Methods: The study comprised a cross-sectional, anonymous, national survey of UK dietitians. Results: There were 207 completed responses (3% response rate). More dietitians reported using combined approaches (COMB) [n = 129 (62%)] over food-based (FB) strategies [n = 70 (34%)] or oral nutritional supplements (ONS) alone [n = 8 (4%)] (N = 207, P < 0.001). Intervention choice was associated with clinical setting and clinical speciality; community dietitians reported more frequent use of FB or ONS alone [n = 48 (59%)] versus COMB [n = 34 (41%)] compared to acute dietitians [COMB: n = 83 (78%) COMB versus FB or ONS alone: n = 24 (22%)] (N = 207, P < 0.0001). Specialist nutrition support dietitians reported more frequent use of FB or ONS alone [n = 22 (54%)] versus COMB [n = 19 (46%)] compared to nonspecialists [FB or ONS alone: n = 17 (45%) versus COMB: n = 21 (55%)] and other specialist dietitians [FB or ONS: n = 39 (30%) alone versus COMB: n = 89 (70%)] (P = 0.017). The greatest influences on choice were ease of implementation [n = 192 (93%)], departmental protocols [n = 184 (89%)], professional management pathways [n = 179 (87%)] and published research [n = 165 (80%)]. Patient circumstances [n = 117 (57%) and n = 99 (48%)] and ease of implementation [n = 35 (17%) and n = 48 (24%)] were reported as most influential in the first and second case scenarios, respectively. Conclusions: There is a need for further research on approaches to the dietetic management of adult malnutrition.108

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“…[5][6][7] Yet, recent evidence indicates that many patients undergoing lower gastrointestinal surgery do not recommence nutritionally adequate diets within timeframes outlined by guidelines, nor do they meet their nutrition requirements while in hospital. [8][9][10][11][12] As such, patients are not exposed to the potential benefits associated with EOF and may incur longer lengths of stay and increased incidence of complications if poor oral intakes persist. 13 Clearly, strategies are required to translate evidence-based nutrition recommendations into habitual practice to improve patient and healthcare outcomes.…”

Section: Introductionmentioning

confidence: 99%

Hospital Staffs’ Perceptions of Postoperative Nutrition Among Colorectal Patients: A Qualitative Study

et al. 2019

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Background After lower gastrointestinal surgery, few patients start eating within timeframes outlined by evidence‐based guidelines or meet their nutrition requirements in hospital. The present study explored hospital staffs’ perceptions of factors influencing timely and adequate feeding after colorectal surgery to inform future interventions for improving postoperative nutrition practices and intakes. Methods This qualitative exploratory study was conducted at an Australian hospital where Enhanced Recovery After Surgery guidelines had not been formally implemented. One‐on‐one semistructured interviews were conducted with hospital staff who provided care to patients undergoing colorectal surgery. Interviews lasted from 21 to 47 minutes and were audio recorded and transcribed verbatim. Data were analyzed using inductive thematic analysis. Emergent themes and subthemes were discussed by all investigators to ensure consensus of interpretation. Results Eighteen staff participated in interviews, including 9 doctors, 5 nurses, 2 dietitians, and 2 foodservice staff. Staffs’ responses formed 3 themes: (1) variability in perceived acceptability of postoperative feeding; (2) improving dynamics and communication within the treating team; and (3) optimizing dietary intakes with available resources. Conclusion Staff and organizational factors need to be considered when attempting to improve postoperative nutrition among patients who undergo colorectal surgery. Introducing a feeding protocol, enhancing intraprofessional and interdisciplinary communication, and ensuring the availability of appropriate, nutrient‐dense foods are pivotal to improve nutrition practices and intakes.

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A systematic review of feeding practices among postoperative patients: is practice in‐line with evidenced‐based guidelines?

Abstract: Our findings demonstrate a gap between postoperative feeding evidence and its practical application. This information provides a strong rationale for interventions targeting improved nutritional care following surgery.

Cited by 25 publications

References 88 publications

A qualitative exploration of patients’ experiences with and perceptions of recommencing feeding after colorectal surgery

A qualitative exploration of patients’ experiences with and perceptions of recommencing feeding after colorectal surgery

Oral nutrition support interventions for patients who are malnourished or at risk of malnutrition: a survey of clinical practice amongst UK dietitians

Hospital Staffs’ Perceptions of Postoperative Nutrition Among Colorectal Patients: A Qualitative Study

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