Comparison of a 24-hour rate-based protocol to a 20-hour volume-based protocol on enteral nutrition delivery in a private intensive care unit.

Abstract

At Epworth HealthCare, enteral nutrition (EN) targets in have historically been based on continuous hourly rate-based protocols (RBP). The 2016 ASPEN/SCCM guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient support the use of a volume-based protocol (VBP) as they have been shown to empower nursing staff and increase the EN delivery. The adequacy of EN delivery in Epworth Richmond (ER) Intensive Care Unit (ICU) patients, had not been accurately quantified until the 2018 ER-ICU enteral feeding audit. This audit identified ER-ICU enterally fed patients received on average 75% of EN target volume daily and had feeds ceased for an average of 3.6 hours per day (most frequently between 0600-1000). Following the 2018 audit, practice was changed to deliver EN in ER-ICU via a 20-hour VBP. Audit data was used to develop a protocol tailored to the needs of ER-ICU, specifically the time of feeding cessation and the duration. The VBP provides EN from 1000-0600 hours, as 0600-1000 was identified as the priority time for fasting and extubation. It also includes a nursing driven “catch up rate” step to ensure the delivery of EN target volume each day.