Consistent nutrition support protocols can help prevent malnutrition in critically ill patients, improve outcomes

"Interruptions in Enteral Nutrition Delivery in Critically Ill Patients and Recommendations for Clinical Practice" offers specific strategies to address underfeeding and decrease the time patients spend without nutrition.

Author Melissa L. Stewart, RN, DNP, MSN, CCNS, CCRN, is a staff nurse in the medical intensive care unit at the University of Kentucky Chandler Medical Center in Lexington.

"Critical care nurses spend more time at the bedside than other healthcare providers and are well positioned to monitor nutrition delivery," she said. "Malnutrition is common in critically ill patients, and the use of a nutrition support protocol can help improve patients' outcomes."

In the article, Stewart reviews the latest research related to enteral nutrition, also known as tube feeding, which is the feeding method of choice for critically ill adult patients.

Enteral nutrition is often interrupted because of procedures, positioning, technical issues with feeding accesses and gastrointestinal intolerance issues, which may lead to underfeeding.

Deteriorating nutritional status while hospitalized is strongly associated with prolonged length of stay, increased cost of hospitalization and higher mortality.

The article encourages the development and use of nutrition support protocols to offer guidance to bedside nurses when addressing issues commonly encountered with enteral feedings, including initiation of feedings and feeding intolerance, as well as advancement and discontinuation of enteral nutrition.

Protocols are effective in increasing the amount of nutrients provided to critically ill patients and decreasing the amount of time necessary to reach target nutrition goals.

Other evidence-based strategies for treating or preventing malnutrition include:

• head of bed positioning

• use of prokinetic medications

• use of a higher threshold when monitoring gastric residual volumes

• postpyloric feeding access

The article also encourages nurses to work with other members of the multidisciplinary team to develop and implement interventions to prevent and treat malnutrition, including efforts to limit the amount of time nutrition delivery is interrupted due to procedures.