Improvement of enteral nutrition in intensive care unit patients by a nurse-driven feeding protocol

To examine whether early enteral nutrition (EN) of critically ill patients could be improved by a nurse-driven implementation of an existing feeding protocol.

Before and after design.

Responsibility for starting and timely escalating EN - subject to physician's ordering before - was assigned to the intensive care unit (ICU) nursing staff. A short written instruction was extracted from the comprehensive standard operating procedure (SOP) for nutrition. The nursing team was trained to use this instruction; after completing the training they managed early EN autonomously. Time to start of enteral feeding and applied quantity in the first 5 ICU days were recorded prospectively for the patients treated during the following 6 months. The data were compared to a retrospectively analysed cohort from 6 months before, which was fed according to the SOP-based prescription of the physician on duty.

A total of 101 and 97 patients were included, respectively, before and after the intervention. Following intervention, enteral feeding started significantly earlier (28 ± 20 h versus 47 ± 34 h, p<0.001), within 24 h in 64% versus 25% (p<0.0001); and for each of the first 5 days, the proportion of patients meeting their nutritional goal was significantly higher.

Assigning the responsibility for implementation of an existing SOP to the nursing team led to earlier start of enteral feeding and more frequent achievement of caloric targets in ICU patients.

Adherence to guidelines regarding early start and timely escalation of EN can be improved if ICU nursing staff is responsible for translating it into action with the help of a written algorithm.