Protocols Needed to Help Prevent Malnutrition in Critically Ill Patients, Improve Outcomes

Newswise — Varying practices and frequent lapses in nutrition delivery can put critically ill patients at greater risk for malnutrition and associated complications, according to an article in the August issue of Critical Care Nurse (CCN).

“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.

As the American Association of Critical-Care Nurses’ bimonthly clinical practice journal for high acuity, progressive and critical care nurses, CCN is a trusted source for information related to the bedside care of critically and acutely ill patients.

Access the article abstract and full-text PDF by visiting the CCN website at www.ccnonline.org.

About Critical Care Nurse: Critical Care Nurse (CCN), a bimonthly clinical practice journal published by the American Association of Critical-Care Nurses, provides current, relevant and useful information about the bedside care of critically and acutely ill patients. The journal also offers columns on traditional and emerging issues across the spectrum of critical care, keeping critical care nurses informed on topics that affect their practice in high acuity, progressive and critical care settings. CCN enjoys a circulation of more than 100,000 and can be accessed at www.ccnonline.org.

About the American Association of Critical-Care Nurses: Founded in 1969 and based in Aliso Viejo, Calif., the American Association of Critical-Care Nurses (AACN) is the largest specialty nursing organization in the world. AACN joins together the interests of more than 500,000 acute and critical care nurses and claims more than 235 chapters worldwide. The organization’s vision is to create a healthcare system driven by the needs of patients and their families in which acute and critical care nurses make their optimal contribution. www.aacn.org; facebook.com/aacnface; twitter.com/aacnme