The physician-nurse collaboration in feeding critically ill patients: A multicenter survey

Mei, Binbin; Wang, Wenting; Shen, Meifen; Cui, Feifei; Wen, Zunjia; Ding, Jianping

doi:10.1016/j.apnr.2017.05.007

Cited by 5 publications

(4 citation statements)

References 26 publications

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“…A meta‐analysis done in 2017 by Binbin Mei et al [16] on 1845 patients undergoing colorectal cancer surgery showed similar results of reduced time to pass first flatus ( p 0.006), first bowel movement ( p < 0.0001), and total length of hospital stay ( p 0.001) as observed in this study, which further strengthen our results.…”

Section: Discussionsupporting

confidence: 89%

Role of Chewing Gum in Reducing Postoperative Ileus after Reversal of Ileostomy: A Randomized Controlled Trial

et al. 2021

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Background Postoperative ileus is one of the most prevalent and troublesome problems after any elective or emergency laparotomy. Gum chewing has emerged as a new and simple modality for decreasing postoperative ileus. The aim of this study was to determine the effectiveness of chewing gum in reducing postoperative ileus in terms of passage of flatus and total length of hospital stay. Patients and methods This single‐blinded, randomized clinical trial was conducted in department of surgery, Services Hospital Lahore, between November 2013 and November 2015. The patients were divided into two groups: chewing gum (Group A) and no chewing gum (Group B). Starting 6 h after the operation, Group A patients were asked to chew gum for 30 min every 8 h; bowel sounds, passage of flatus and total length of hospital stay were noted. Outcome measures such as passage of flatus and total length of hospital stay in patients undergoing reversal of ileostomy were compared using t‐test. Results Mean age of the patients in Group A was 26.12 (± 7.1) years and in Group B was 28.80 (± 10.5) years. There were 25 males (50%) and 25 females (50%) in Group A. In Group B, there were 29 males (58%) and 21 females (42%). Mean BMI in Group A was 23.5 (± 5.3), and in Group B was 21.4 (± 4.6). The mean time to pass flatus was noted to be significantly shorter, 18.36 (± 8.43) hours, in the chewing group (Group A), whereas in the no chewing gum group (Group B), it was 41.16 (± 6.14) hours (p value < 0.001). The mean length of hospital stay was significantly shorter 84 (± 8.3) hours in the chewing gum group (Group A) as compared to 107.04 (± 6.4) hours in the no chewing gum group (Group B) (p value 0.000). Conclusion It is concluded that postoperative chewing of gum after the reversal of ileostomy is accompanied with a significantly shorter time to passage of flatus and shorter length of hospital stay.

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Section: Discussionsupporting

confidence: 89%

Role of Chewing Gum in Reducing Postoperative Ileus after Reversal of Ileostomy: A Randomized Controlled Trial

et al. 2021

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“…Many literature data have highlighted as in real-life settings the nutritional component of care is burdened by several criticalities involving both the medical and nursing ICU teams (e.g., prescribing undue fasting periods, late involvement of dieticians, insufficient protein and energy, inadequate nurse staffing, poor interprofessional communication), so that nutritional goals are often unmet. [22][23][24][25] A delayed onset of EN, the prescription of inadequate nutritional support (lower or higher than expected), the failure to titrate the administration rate after the initial prescription and the administration of less-than planned EN are frequently encountered situations. [26][27][28][29] Nevertheless, although missing the energy target is a well-known risk factor for negative clinical outcomes in ICU patient receiving EN, 30 at present the debate about the optimal nutritional target in critically ill patients is far from being solved.…”

Section: Discussionmentioning

confidence: 99%

“…We speculate that the reason could be related to the fact that, despite the intention to provide a personalised calorie and protein intake, in daily clinical practice a tendency to prescribe a standard amount of nutritional support regardless of the expected ER may have occurred. Many literature data have highlighted as in real‐life settings the nutritional component of care is burdened by several criticalities involving both the medical and nursing ICU teams (e.g., prescribing undue fasting periods, late involvement of dieticians, insufficient protein and energy, inadequate nurse staffing, poor interprofessional communication), so that nutritional goals are often unmet 22–25 . A delayed onset of EN, the prescription of inadequate nutritional support (lower or higher than expected), the failure to titrate the administration rate after the initial prescription and the administration of less‐than planned EN are frequently encountered situations 26–29 .…”

Section: Discussionmentioning

confidence: 99%

Adequacy of protein and calorie delivery according to the expected calculated targets: a day‐by‐day assessment in critically ill patients undergoing enteral feeding

Fabiani

Dreas

Mazzaro

et al. 2022

J Human Nutrition Diet

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Background In critically ill patients requiring mechanical ventilation for longer than 48–72 h enteral nutrition (EN) should be started early. Because EN alone may be unable to reach the target nutritional requirement, supplemental parenteral nutrition (PN) should be administered. This study aimed at describing the daily rate of administered calories and proteins according to the expected calculated targets. The impact of calorie adequacy, deficit or excess on relevant clinical outcomes was explored. Methods A retrospective cohort study was conducted in 217 patients undergoing cardiac surgery, admitted postoperatively in intensive care unit and undergoing EN. The effective intake provided via EN, PN, oral nutritional supplements (ONS) and nonnutritional calories (NNC) was documented for a maximum of 20 days. The administered/required calorie and protein ratios (KcalA/R, ProtA/R) were calculated daily. Patients receiving 80%–100%, <80% or >100% of KcalA/R and ProtA/R were identified. The association between mean KcalA/R between days 4–7 and 30 days’ mortality was explored. Results A mean KcalA/R ratio of 92.0 ± 40.6% was ensured between days 4 and 20. During days 4–7 the 80%–100% calorie target was achieved in 26.9% of patients, whereas 44.9% were below and 28.2% over this range. EN contributed 47.1% and PN 41.2% to the total energy intake. An increase in 30‐day mortality risk was documented for patients exceeding 100% of KcalA/R ratio (adjusted‐hazard ratio [HR] 5.2; 95% confidence interval [CI] 1.1 –23.9; p = 0.035). Conclusions Despite a preliminary estimate of nutritional requirement, a steady daily optimal 80%–100% KcalA/R was not ensured for all patients. EN contributed only partially to both energy and protein intakes so that PN was largely used to achieve the desired nutritional targets.

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“…The effectiveness of an organization is often determined by the role of leaders who are willing to bring organizational members towards achieving vision, mission, and goals. The leader can provide social effects with a personal approach [47,48], authentic style [49,50], and building of two-way communication [14,[51][52][53][54].…”

Section: Cp Significantly Increases Cpat Perceptionmentioning

confidence: 99%

Effective Clinical Pathway Improves Interprofessional Collaboration and Reduces Antibiotics Prophylaxis Use in Orthopedic Surgery in Hospitals in Indonesia

et al. 2022

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Clinical pathways can improve the quality of health services. The effectiveness and impact of implementing clinical pathways are controversial. The preparation of clinical pathways not only enacts therapeutic guidelines but requires mutual agreement in accordance with the roles, duties, and contributions of each profession in the team. This study aimed to investigate the perception of interprofessional collaboration practices and the impact of clinical pathway implementation on collaborative and Defined Daily Dose (DDD) prophylactic antibiotics per 100 bed-days in orthopedic surgery. The Collaborative Practice Assessment Tool (CPAT) questionnaire was used as a tool to measure healthcare’ perceptions of collaborative practice. The clinical pathway (CP) in this study was adapted from existing CPs published by the Indonesian Orthopaedic Association (Perhimpunan Dokter Spesialis Orthopaedi dan Traumatologi Indonesia, PABOI) and was commended by local domestic surgeons and orthopedic bodies. We then compared post-implementation results with pre-implementation clinical pathway data using ANCOVA to explore our categorical data and its influence towards CPAT response. ANOVA was then employed for aggregated DDD per 100 bed-days to compare pre and post intervention. The results showed that the relationships among members were associated with the working length. Six to ten years of working had a significantly better relationship among members than those who have worked one to five years. Interestingly, pharmacists’ leadership score was significantly lower than other professions. The clinical pathway implementation reduced barriers in team collaboration, improved team coordination and organization, and reduced third-generation cephalosporin use for prophylaxis in surgery (pre: 59 DDD per 100 bed-days; post: 28 DDD per 100 bed-days). This shows that the clinical pathway could benefit antibiotic stewardship in improving antibiotic prescription, therefore reducing the incidence of resistant bacteria.

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The physician-nurse collaboration in feeding critically ill patients: A multicenter survey

Cited by 5 publications

References 26 publications

Role of Chewing Gum in Reducing Postoperative Ileus after Reversal of Ileostomy: A Randomized Controlled Trial

Role of Chewing Gum in Reducing Postoperative Ileus after Reversal of Ileostomy: A Randomized Controlled Trial

Adequacy of protein and calorie delivery according to the expected calculated targets: a day‐by‐day assessment in critically ill patients undergoing enteral feeding

Effective Clinical Pathway Improves Interprofessional Collaboration and Reduces Antibiotics Prophylaxis Use in Orthopedic Surgery in Hospitals in Indonesia

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