Implementation of an Evidence-based Feeding Protocol and Aspiration Risk Reduction Algorithm

Abstract

Aspiration pneumonia is a serious complication of mechanical ventilation and enteral tube feedings. It results in increased patient mortality, increased length of hospital stay, and increased healthcare costs. This article describes an evidence-based practice approach to the creation of an enteral feeding protocol and an aspiration risk reduction algorithm. These tools were piloted in a Medical Intensive Care Unit at a Midwest tertiary care center. Chart audits show an increase in the percentage of patients who reach their goal rate for enteral feedings from 78% to 85%. Reported aspiration pneumonias decreased from an average count of 4.8 patients per month to 4.3 per month and ventilator-associated pneumonia rates decreased from 6.8 to 3.2 per 1000 patient days.

A practice change initiative to improve the provision of enteral nutrition to intensive care patients

“…The most common recommended action was to reduce the EN infusion rate (Cerra et al , ; Jolliet et al , ; Stroud et al , ; National Collaborating Centre for Acute Care, ; National Institute for Health & Clinical Excellence, ). Other recommendations included to cease the EN (American Society for Parenteral and Enteral Nutrition Board of Directors and The Clinical Guidelines Task Force, ; Bowman et al , ; Kattelmann et al , ), to introduce prokinetics (Jolliet et al , ; Heyland et al , ; National Collaborating Centre for Acute Care, ; National Institute for Health & Clinical Excellence, ), to monitor the patient closely (Edwards and Metheny, ; McClave and Snider, ), or to implement aspiration risk reduction methods (McClave and Snider, ; Martindale et al , ). Next we consider how the interruptions to EN delivery prior to procedures might be addressed.…”

Evidence Into Practice: Publishing an Evidence-Based Practice Project

“…Include patient population, project focus or topic, specialty (if applicable), and indication of an EBP project Bowman et al 15 …”

Minimizing tracheobronchial aspiration in patients on tube feedings, part 2

“…28,29 An advanced practice nurse could take the lead to review the literature, develop enteral feeding protocols, and educate and encourage the interdisciplinary team to adopt these protocols. Ideally, enteral nutrition clinical pathways or algorithms should be developed for GRV checks, and should specify the GRV level that warrants holding administration of tube feeding; GI assessment; minimizing sedation; using prokinetic agents; and indications for transition to a small bowel feeding tube.…”