Implementation of a best‐practice guideline: Early enteral nutrition in a neuroscience intensive care unit

Abstract

Current evidence suggests that early enteral nutrition is a best practice and leads to improved clinical outcomes. An evidence‐based practice project was implemented in a busy neurointensive care unit in a midwestern tertiary care facility that was designed to improve care by implementing the early nutrition portion of Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient: Society of Critical Care Medicine and the American Society for Enteral and Parenteral Nutrition. The Registered Nurses’ Association of Ontario's (RNAO) Toolkit: Implementation of Best Practice Guidelines (BPGs) was selected and followed to guide implementation and achieve optimal results. During a 90‐day implementation period, this project resulted in a 100% improvement in early nutrition. Interventions included the use of a series of cards that reminded the team to order enteral nutrition and prepacked bundles of nasogastric tube supplies. The RNAO toolkit served as a structured and effective step‐by‐step methodology for the implementation of a BPG.

Knowledge Level of ICU Nurses Regarding Nutritional Assessment of Critically Ill Patients: A Systematic Review

“…The quasi-experimental studies [ 53 , 54 ] and the retrospective study [ 45 ] have been classified as having a low risk of bias because they had a more robust design with a greater capacity to control errors [ 38 , 39 , 40 , 41 ].…”

“…In addition, it was noted that EN-related nursing care was consistently documented when associated with other patient priorities, with EN being given higher priority in more stable patients [ 56 ]. Surveys conducted by several authors [ 46 , 48 , 54 ] (prior to the implementation of the contemplated nutrition education program) found that the main individual and team barriers to initiating optimal EN were feeding intolerance, standard nursing practices, severity of illness, lack of knowledge and beliefs that new guidelines would not change current practices. After the educational interventions were implemented [ 54 ], the level of knowledge of professionals regarding EN improved by up to 81%, interdisciplinary communication increased and feeding initiation times and complications were reduced [ 53 , 54 ].…”

“…Surveys conducted by several authors [ 46 , 48 , 54 ] (prior to the implementation of the contemplated nutrition education program) found that the main individual and team barriers to initiating optimal EN were feeding intolerance, standard nursing practices, severity of illness, lack of knowledge and beliefs that new guidelines would not change current practices. After the educational interventions were implemented [ 54 ], the level of knowledge of professionals regarding EN improved by up to 81%, interdisciplinary communication increased and feeding initiation times and complications were reduced [ 53 , 54 ]. In addition, they noted that positive attitudes toward a change in current guidelines led to a better success rate of the educational program [ 47 , 52 , 54 ].…”

“…After the educational interventions were implemented [ 54 ], the level of knowledge of professionals regarding EN improved by up to 81%, interdisciplinary communication increased and feeding initiation times and complications were reduced [ 53 , 54 ]. In addition, they noted that positive attitudes toward a change in current guidelines led to a better success rate of the educational program [ 47 , 52 , 54 ].…”

“…It was also identified that these functions were recorded to a lesser extent during the beginning of the shift. After various educational interventions, activities associated with nutritional care improved significantly [ 53 ], as did the time to initiate enteral feeding, with a reduction from a mean of 53.6 h pre-intervention to a mean of 40.2 h post-intervention [ 54 ] (the improvements were statistically significant). In addition, 71% of respondents stated that nutrition education interventions improved communication, and 81% felt that these measures were helpful in initiating early NE.…”