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Clinical Decision Support Tools and a Standardized Order Set Enhances Early Enteral Nutrition in Critically Ill

Keegan J Ziemba1,2, Rajeswari Kumar1, Kathryn Nuss1

  • 1Nationwide Children's Hospital, Columbus, Ohio, USA.

Nutrition in Clinical Practice : Official Publication of the American Society for Parenteral and Enteral Nutrition
|April 2, 2019
PubMed

Insights

Implementing an enteral nutrition (EN) algorithm in a pediatric intensive care unit (PICU) improved early nutrition delivery and reduced length of stay. This nutrition protocol enhanced patient outcomes for critically ill children.

Area of Science:

  • Pediatric Intensive Care
  • Clinical Nutrition
  • Quality Improvement

Background:

  • Critically ill children in the PICU face malnutrition due to complex nutrition needs.
  • Early achievement of caloric goals is linked to better outcomes in pediatric patients.
  • Current nutrition delivery methods in PICU settings are often suboptimal.

Purpose of the Study:

  • To implement an enteral nutrition (EN) algorithm in a tertiary care PICU.
  • To utilize clinical decision support tools (CDSTs) and standardized order sets for nutrition management.
  • To improve the delivery of nutrition to critically ill children.

Main Methods:

  • A quality improvement initiative was conducted.
  • An EN feeding protocol was implemented using electronic CDSTs.
  • A standardized order set was integrated into the electronic health record.

Main Results:

  • Pre-implementation, only 18% of patients met goal EN within 48 hours.
  • Post-implementation, 88% of patients achieved goal feed volume within 48 hours.
  • Significant improvements were observed in time to start EN, time to goal nutrition, and reduced PICU length of stay.

Conclusions:

  • CDSTs and standardized order sets effectively facilitated the implementation of a nutrition algorithm.
  • The nutrition algorithm likely improved the nutrition care of critically ill children.
  • This initiative demonstrates a successful strategy for optimizing EN delivery in the PICU.
Abstract

Keywords:
childcritical illnesselectronic health recordsenteral nutritionnutrition supportpediatric intensive care unitpediatricsquality improvement

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