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Implementing the PEP uP Protocol in Critical Care Units in Canada: Results of a Multicenter, Quality Improvement

Daren K Heyland1, Rupinder Dhaliwal2, Margot Lemieux2

  • 1Clinical Evaluation Research Unit, Kingston General Hospital, Kingston, Ontario, Canada Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada Department of Medicine, Queen's University, Kingston, Ontario, Canada dkh2@queensu.ca.

JPEN. Journal of Parenteral and Enteral Nutrition
|April 22, 2014
PubMed

Insights

The Enhanced Protein-Energy Provision via the Enteral Route Feeding Protocol (PEP uP) improved enteral nutrition delivery in Canadian ICUs. Critically ill patients received significantly more energy and protein with the PEP uP protocol.

Area of Science:

  • Critical Care Medicine
  • Clinical Nutrition
  • Quality Improvement Science

Background:

  • Iatrogenic underfeeding is prevalent in intensive care unit (ICU) patients.
  • A novel enteral feeding protocol, PEP uP, was previously shown to be safe and effective in experimental settings.
  • Barriers to adequate enteral nutrition (EN) delivery in ICUs are well-documented.

Purpose of the Study:

  • To evaluate the implementation of the PEP uP protocol in real-world Canadian ICUs.
  • To assess the impact of the PEP uP protocol on EN delivery and patient outcomes.
  • To compare nutrition practices between ICUs using the PEP uP protocol and control ICUs.

Main Methods:

  • A multicenter quality improvement initiative with a concurrent control group design.
  • Eight Canadian ICUs implemented the PEP uP protocol.
  • Sixteen Canadian ICUs served as concurrent control sites, with nutrition practices and outcomes compared.

Main Results:

  • Patients at PEP uP sites received 60.1% of prescribed energy needs via EN, versus 49.9% in control sites (P = .02).
  • Protein delivery was significantly higher in PEP uP sites (61.0% vs 49.7%; P = .01), with increased use of protein supplements (71.8% vs 47.7%; P = .01).
  • More patients in PEP uP sites achieved >80% of protein requirements by day 3 (46.1% vs 29.3%; P = .05).

Conclusions:

  • The PEP uP protocol is effective in improving EN delivery in real-world clinical settings.
  • Implementation of the PEP uP protocol enhances energy and protein provision for critically ill patients.
  • The PEP uP protocol offers a viable strategy to overcome barriers to adequate nutrition in the ICU.
Abstract

Keywords:
caloric intakecritical careenergy balancefeeding protocolsnutrition statusnutrition therapyquality improvementunderfeeding

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