Year of Publication

2020

Degree Name

Doctor of Nursing Practice

Committee Chair

Dr. Martha Biddle

Clinical Mentor

Dr. Paula Holcomb

Committee Member

Dr. Cassie Degener

Abstract

Introduction: Delayed enteral nutrition in critically ill patients increases the risk of complications and poor outcomes. Current evidence-based guidelines recommend initiation of enteral nutrition within 24-48 hours of intensive care unit (ICU) admission. The quality improvement (QI) project aim was to examine whether enteral nutrition was initiated within 24- 48 hours of mechanical ventilation after implementation of QI intervention in order to determine practice change.

Methods: The QI protocol was introduced to the Cardiovascular ICU (CVICU) at UK Chandler Hospital (UKHC) nurses via an education session. A post-education electronic survey identified the nurse’s understanding of the protocol. To identify nursing practice changes of enteral nutrition initiation in mechanically ventilated patients, a pre-post project design was conducted.

Results: Twenty two CVICU nurses anonymously completed surveys after receiving an educational session. All of the nurses reported an understanding of the contraindications for enteral nutrition. Twenty one of the 22 nurses (95.45%) understood when to discuss enteral nutrition initiation with a provider, and 19 (86.36%) reported an understanding of when to initiate enteral nutrition based on guideline recommendations. Of the 83 medical records analyzed that met inclusion criteria, five patients before the educational intervention and three patients after the educational intervention received enteral nutrition. There was no difference in the mean number of hours regarding enteral nutrition initiation time after mechanical ventilation for the pre-design intervention and the post-design intervention (M=61.6 vs M=50.0, p- value=0.66).

Conclusion: This QI project recognized there was a gap in the time it takes for enteral nutrition to be initiated after mechanical ventilation despite established guidelines. The practice gap identified in this QI project was not addressed with one educational session and did not have an impact in decreasing the time to initiate enteral nutrition after mechanical ventilation. Adherence to evidenced based practice guidelines and enhancement of nurse autonomy can potentially improve implementation of a nurse driven protocol for initiation of enteral nutrition in the mechanically ventilated patient population.

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