Multidisciplinary evaluation of a critical care enteral feeding algorithm

Abstract

Aim: Feeding algorithms have been demonstrated to improve nutrition delivery and influence primary outcomes in critical care units. Most feeding algorithms assist decision‐making related to initiation of enteral nutrition, use of prokinetics and the mode of delivery of feeding. The algorithm that is the subject of this evaluation enabled nursing staff to select type of feed and target feeding rate for enterally fed patients. The aims of this evaluation were to assess acceptance of the algorithm across disciplines, and to determine if energy and protein intakes achieved were comparable with data reported in an international multi‐centre observational study. Methods: Semistructured interviews were conducted with eight nurses, three doctors and three dietitians, to gauge their attitudes towards usefulness of the algorithm. Data on energy and protein intakes was collected for 108 patients using nursing observation records of volume of feed delivered with deductions for discarded aspirates. Results: Positive feedback on usability of the algorithm was given by all interview participants. Common themes from the interviews were that the algorithm ‘enabled feeding to start earlier’, ‘was simple to use’ and ‘ensured consistency of approach’. Greater than 80% of estimated nutritional targets were achieved, and enteral feeding commenced on average within 8 hours. Conclusions: Evaluation of the new feeding algorithm indicated that it was well accepted by users, ensured a consistent approach to enteral feeding delivery and enabled feeding to start earlier within an intensive care unit.

Investigating critical care nurses' perception regarding enteral nutrition

“…Nursing administrators need to make this issue as part of the nursing orientation along with frequent checks that nurses know the guidelines and they are following them. The availability of EN guidelines that are based on the current evidences is crucial for critical care nurses to perform EN consistently (Woien and Bjork, 2006;Reeves et al, 2012).…”

Enteral nutrition feeding practices by intensive care nurses: A retrospective evaluation

“…This could be rectified by implementation of decision algorithms to assist nurses to select the right feeding combinations for patients. The merit of this practice change has been highlighted in the literature, 4,15,17,18 whereby following implementation of a nurse-led feeding protocol more patients were found to achieve their caloric target within a shorter timeframe following ICU admission. 4,17,18 Lack of documentation explaining reasons for delayed EN commencement and the failure to meet nutrition requirements was a common finding in our study and consistent with the current literature.…”

“…This could be rectified by implementation of decision algorithms to assist nurses to select the right feeding combinations for patients. The merit of this practice change has been highlighted in the literature, 4, 15, 17, 18 whereby following implementation of a nurse‐led feeding protocol more patients were found to achieve their caloric target within a shorter timeframe following ICU admission 4, 17, 18 …”

The Effect of Enteral Tube Feeding on Patients’ Health-Related Quality of Life: A Systematic Review

“…Similarly, the pathophysiology of the long-term conditions requiring enteral tube feeding such as stroke, Crohn’s disease and cancers are different [43,44], and the differing treatment options may also have implications for patients’ QoL. The settings where the studies included took place varied from the community such as HEN to acute hospitals [2,43,45] and these different settings may also influence the impact of enteral tube feeding on patients’ QoL. Methods of enteral feeding could be in the form of bolus, gravity and the use of stationary or mobile enteral feeding pumps and each of these enteral feeding methods have their advantages and drawbacks in terms of how they impact patients’ QoL [46].…”