(467) Improving Enteral Nutrition in ICU Patients: A Quality Improvement Project

Tuesday, February 25, 2025

11:15am – 12:15pm Eastern Time

Location: Connections Central - RST 12

First Author(s)

divakar sharma, MD

Lehigh Valley Health Network
Lehigh Valley Health Network
Bethlehem, Pennsylvania, USA

Co-Author(s)

MD

Mary Ann Devine, MD

ICU director
Lehigh Valley Health Network, United States

Introduction: Adequate nutrition decreases mortality and improves functional outcomes in Intensive care unit (ICU) patients. Unfortunately, underfeeding is a widespread problem. We identified this problem and conducted a quality improvement project to improve enteral nutrition in ICU patients.

Methods: The project was implemented between April to November 2023 in a mixed medical surgical ICU. Mechanically ventilated patients who got enteral nutrition for more than 2 days in ICU were included in the study. Nutritionist recommended the daily tube feed goal for every patient based on Penn state equation. We used ASPEN guideline as our benchmark that patients should get at least 80% of recommended daily calories. The goal for the project was set that patients should receive recommended tube feeding amount for more than 80% of the duration of ICU stay. Data was collected from nursing flow sheet in the electronic medical record. We calculated the amount of tube feeds (in ml) each patient got per shift. It was compared against the recommended tube feed goal. We measured the percentage of shifts, the patient received at least 80% of recommended calorie goal. Nursing staff were educated weekly and nutrition goals for every patient were identified on ICU rounds at baseline. Baseline data was collected. During the first cycle, the intervention was to continue tube feeding during ventilator weaning trials. As the goal was not achieved, a second intervention was made. Patients were given an extra amount of tube feed after calculating prior day deficit (catch up) if present.

Results: At baseline,101/185 of shifts (56.7%), patients got more than 80% of recommended calories. After the first intervention of continuing tube feeds during weaning trials, 109/151of shifts (72%) patients achieved the goal. After the second intervention of catching up on the nutrition deficit, 91/117 of shifts (85%) patients received the recommended tube feeding goal.

Conclusions: Undernutrition in ICU patients can be improved by identifying nutrition deficit on daily ICU rounds, continuing tube feeding during ventilator weaning trials and providing the goal deficit as catch up amount the next day.