(1283) Air, Food, and Water: Assessing Resident Confidence in Management of Enteral Nutrition in the ICU

Introduction: Mechanically Ventilated patients are dependent on parenteral or enteral nutrition for not only sustenance but also recovery. Critical illness is a catabolic state with systemic inflammation and organ dysfunction. Nutrition in such settings is believed to help attenuate the metabolic response to these stressors, decreasing free radical injury and improving patient outcomes. Guidelines have thus emphasized the evolution of nutrition support to nutrition therapy (NT) (1). However, the severity of illness in these patients and urgent pharmacological interventions often push NT into the backseat, which breeds fertile ground for overlooking nutrition, frequently leading to delays in initiation and uncertainty with management. In a study, delayed NT was strongly associated with an order placement by an MD compared with a dietitian and the use of vasopressors within 48 h of ICU (2). Therefore, we must actively seek out the reasons and effectively address them.

Methods: We have designed a semi-quantitative questionnaire to assess how comfortable Resident Physicians are with initiating and managing enteral nutrition in patients on MV. The Residents will fill in a voluntary online form composed of 4 questions before any intervention as a pre-survey. The intervention will be a resident education and discussion session outlining the importance of nutrition therapy, evidence-based recommendations for the same, the problems usually encountered, and practical solutions. Residents will then be asked to answer a post-survey questionnaire.

Results: A total of 38 residents were surveyed - the pre-survey had a rate of 35.1% correct responses (Mean 33.1 with a SD of 18), which had improved to 78.9% (Mean 78.3 with a SD of 22.5) after the intervention, an improvement of about 124%.

Conclusions: The data highlights an improvement in the participants' knowledge and confidence in enteral nutrition, as evidenced by the increase in the percentage of correct responses from the pre-survey to the post-survey.
These surveys have provided us with vital information about resident confidence in nutrition therapy and helped improving it.
We must strive to achieve expertise in such a vital aspect of patient care, and we believe this project has taken us in the right direction, improving the quality of care our patients receive.