Enteral Nutrition in Adult Patients in the Critical

Enteral Nutrition in Adult Patients in the Critical Care Setting Mindy M Blodgett BSN, RN, Paul A Jackman BSN, RN, and Melissa D Ziesman BSN, RN Creighton University METHODS INTRODUCTION Malnourished patients in the hospital are at risk for poor outcomes including • Increased lengths of stay (LOS) • Readmissions • Mortality • Higher hospital costs Correlation between early enteral nutrition and improved outcomes in intensive care unit (ICU) patients (Nguyen et al. , 2012; Woo et al. , 2010). Setting • 25 bed intensive care unit • Diagnoses include cardiovascular, neurological, medical, surgical, and trauma conditions. Design • Retrospective Chart Review • Admitted or transferred into the ICU between January 1, 2013 and June 30, 2013. Purpose Statement Project Purpose • Improve patient outcomes • Increase health care provider and staff knowledge by reviewing current practices and comparing to current guidelines • Provide data to the research community Data Collection Clinical Findings Demographic Data • Age, gender, weight, serum nutritional markers, number of days prior to initiation of enteral nutrition, and mechanical ventilation • Inconsistent initiation of enteral nutrition • No standard for weight measurement • Inconsistent serum • Lack of documentation regarding type of enteral nutrition, rate, etc. Outcomes • Mortality, ICU LOS, 30 -day readmissions, and complications. Exclusion Criteria • Less than 19 years of age, ICU level care less than 48 hours, RESULTS PO diet orders, advanced directives Conflicting evidence, lack of standardized protocols, and lack of adherence. We have sought to investigate the timing of enteral nutrition initiation and its relationship with mortality, ICU LOS, 30 -day readmissions, and complications. CONCLUSION Timing of Enteral Nutrition 55 50 6 0 Impact on: • Mortality • ICU LOS • 30 -day readmission The number of eligible patients in the study out of the 104 reviewed charts. The number of patients requiring mechanical ventilation. Eleven developed either aspiration pneumonitis or HAP/VAP. The number of patients that were readmitted to this hospital within 30 days of discharge. The number of patients that had documentation of tube feeding residuals exceeding 500 ml. The results of our scholarly project are not consistent with the results of previous studies that have shown benefit to early enteral nutrition. Supports need to update standards for recognition and diagnosis as Jensen et al. reported in 2009. Challenges to the current standards for diagnosing and treating malnutrition in the critical care setting. Future Study ACKNOWLEDGEMENTS Recommendations We would like to extend thanks to: • Prospective trial. Creighton • Dr. Lindsay Iverson, • Standardize processes University • Larger sample size • Dr. Chris Wichman, Creighton University CONTACT • Mary Jo Fike INFORMATION Mindy Blodgett – mindyblodgett@creighton. edu Paul Jackman – pauljackman@creighton. edu Melissa Ziesman –