Increasing the Volume of Delivered Enteral Feeds Using a Volume-Based Feeding Protocol in a Neuroscience Intensive Care Unit

• Published in: Critical care nurse Vol. 44; no. 3; pp. 54 - 64
• Main Authors: Smith, Jr, L Douglas, Hoy, Haley, Whitmore, Sage
• Format: Journal Article
• Language: English
• Published: United States 01-06-2024
• Subjects: Adult; Aged; Clinical Protocols; Critical Care - methods; Critical Care - standards; Critical Care Nursing - standards; Critical Illness - nursing; Critical Illness - therapy; Enteral Nutrition - methods; Enteral Nutrition - nursing; Enteral Nutrition - standards; Female; Humans; Intensive Care Units; Male; Malnutrition - prevention & control; Middle Aged; Neuroscience Nursing; Quality Improvement
• ISSN: 0279-5442; 1940-8250; 1940-8250
• DOI: 10.4037/ccn2024622

Iatrogenic malnutrition is a significant burden to patients, clinicians, and health care systems. Compared with well-nourished patients, underfed patients (those who receive less than 80% of their daily energy requirement) have more adverse outcomes related to nutritional status. Volume-based protocols allow for catch-up titrations, are consistently superior to rate-based protocols, and can be implemented in most settings.
This project was conducted in an 8-bed neuroscience intensive care unit in which up to 41% of patients who required enteral feeding were underfed.
This quality improvement clinical practice change project used a before-and-after design to evaluate (1) the effect of implementing a volume-based feeding protocol on the delivery of enteral feeds and (2) the effect of a nutrition-based project on staff members' attitudes regarding nutrition in critical care. The effectiveness of a volume-based feeding titration protocol was compared with that of a rate-based feeding protocol for achieving delivery of at least 80% of prescribed nutrition per 24-hour period. Staff members' attitudes were assessed using a survey before and after the project.
During 241 enteral feeding days (n = 40 patients), the percentage of delivered enteral feeding volume and the percentage of days patients received at least 80% of the prescribed volume increased after volume-based feeding was implemented. After project implementation, 74 staff members reported increased emphasis on nutrition delivery in their practice and a higher level of agreement that nutrition is a priority when caring for critically ill patients.
Using a volume-based feeding protocol with supplemental staff education resulted in improved delivery of prescribed enteral feeding.