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Evaluation of implementation of fasting guidelines for enterally fed critical care patients

Evaluation of implementation of fasting guidelines for enterally fed critical care patients
Evaluation of implementation of fasting guidelines for enterally fed critical care patients
Background & aimsCritically ill adults have increased nutrition risk. Prior to procedures patients are often fasted, leading to nutritional deficits. The use of fasting guidelines may therefore help reduce deficits from accumulating. The aim of this work was to determine the impact on nutrition support delivery following the implementation of fasting guidelines in addition to characterizing staff knowledge of the guidelines.DesignRetrospective data were collected on n = 74 patients at two different time points; prior to launch of fasting guidelines and post launch, with regards to estimated nutritional requirements, nutritional targets, volume of enteral nutrition (EN) delivered and periods of fasting. Clinical variables of interest were collected for up to 14 days. Questionnaires assessing staff knowledge/barriers to usage of the fasting guidelines were administered to ICU staff.Setting3 ICUs (General, Cardiac and Neurosciences) within University Hospital Southampton NHS Foundation Trust.PatientsMechanically ventilated adults in an ICU and receiving exclusive EN.Measurements and main resultsComparison was made between pre- and post-guideline implementation with statistically significant improvements in the % EN delivered (76.4 ± 11.8 vs. 84.1 ± 10.8 (p = 0.0009)) and duration of feeds withheld (41.5 ± 26.6 vs. 27.6 ± 20.8 h (p = 0.02)). There were non-significant improvements pre- and post-implementation in the % of energy and protein delivered (80.7 ± 16.4 vs. 86.5 ± 17.3 (p = 0.15 (NS)); 74 ± 18.3 vs. 79 ± 18.5 (p = 0.15 (NS))). 77% of staff were familiar with the guidelines, whilst 42% requested further education. The main barriers to guideline compliance were delays and unpredictable timing of procedures, and differing guidance from senior staff and non-ICU teams.ConclusionsImplementation of fasting guidelines led to significant improvements in EN delivery and reduced duration of feed breaks. The use of fasting guidelines is a positive step towards increasing nutrition delivery in the ICU. Further staff education and better planning around procedures is required to promote further adherence to the fasting guidelines.
0261-5614
1-6
Jenkins, Bethan
257a4109-0414-4326-bd47-e52b36d6b274
Calder, Philip C.
1797e54f-378e-4dcb-80a4-3e30018f07a6
Marino, Luise V.
c479400f-9424-4879-9ca6-d81e6351de26
Jenkins, Bethan
257a4109-0414-4326-bd47-e52b36d6b274
Calder, Philip C.
1797e54f-378e-4dcb-80a4-3e30018f07a6
Marino, Luise V.
c479400f-9424-4879-9ca6-d81e6351de26

Jenkins, Bethan, Calder, Philip C. and Marino, Luise V. (2018) Evaluation of implementation of fasting guidelines for enterally fed critical care patients. Clinical Nutrition, 1-6. (doi:10.1016/j.clnu.2018.01.024).

Record type: Article

Abstract

Background & aimsCritically ill adults have increased nutrition risk. Prior to procedures patients are often fasted, leading to nutritional deficits. The use of fasting guidelines may therefore help reduce deficits from accumulating. The aim of this work was to determine the impact on nutrition support delivery following the implementation of fasting guidelines in addition to characterizing staff knowledge of the guidelines.DesignRetrospective data were collected on n = 74 patients at two different time points; prior to launch of fasting guidelines and post launch, with regards to estimated nutritional requirements, nutritional targets, volume of enteral nutrition (EN) delivered and periods of fasting. Clinical variables of interest were collected for up to 14 days. Questionnaires assessing staff knowledge/barriers to usage of the fasting guidelines were administered to ICU staff.Setting3 ICUs (General, Cardiac and Neurosciences) within University Hospital Southampton NHS Foundation Trust.PatientsMechanically ventilated adults in an ICU and receiving exclusive EN.Measurements and main resultsComparison was made between pre- and post-guideline implementation with statistically significant improvements in the % EN delivered (76.4 ± 11.8 vs. 84.1 ± 10.8 (p = 0.0009)) and duration of feeds withheld (41.5 ± 26.6 vs. 27.6 ± 20.8 h (p = 0.02)). There were non-significant improvements pre- and post-implementation in the % of energy and protein delivered (80.7 ± 16.4 vs. 86.5 ± 17.3 (p = 0.15 (NS)); 74 ± 18.3 vs. 79 ± 18.5 (p = 0.15 (NS))). 77% of staff were familiar with the guidelines, whilst 42% requested further education. The main barriers to guideline compliance were delays and unpredictable timing of procedures, and differing guidance from senior staff and non-ICU teams.ConclusionsImplementation of fasting guidelines led to significant improvements in EN delivery and reduced duration of feed breaks. The use of fasting guidelines is a positive step towards increasing nutrition delivery in the ICU. Further staff education and better planning around procedures is required to promote further adherence to the fasting guidelines.

Text Evaluation of Implementation of Fasting Guidelines _ no tracked changes - Accepted Manuscript
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Accepted/In Press date: 22 January 2018
e-pub ahead of print date: 15 February 2018

Identifiers

Local EPrints ID: 417304
URI: https://eprints.soton.ac.uk/id/eprint/417304
ISSN: 0261-5614
PURE UUID: 85084918-b0ad-40ee-afdf-5abcf81386c1

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Date deposited: 29 Jan 2018 17:30
Last modified: 14 Mar 2018 17:30

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Author: Bethan Jenkins
Author: Luise V. Marino

University divisions

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