What Is "Best Achievable" Practice in Implementing the Enhanced Protein‐Energy Provision via the Enteral Route Feeding Protocol in Intensive Care Units in the United States? Results of a Multicenter, Quality Improvement Collaborative. Issue 2 (12th December 2017)

• Record Type: Journal Article
• Authors: Heyland, Daren K.; Lemieux, Margot; Shu, Lin; Quisenberry, Kristen; Day, Andrew G.
• Is Part Of: JPEN, Journal of parenteral and enteral nutrition. Volume 42:Issue 2(2018)
• Page Start: 308
• Page End: 317
• Publication Date: 2017-12-12
• Subjects: critical care -- nutrition therapy -- nutrition status -- caloric intake -- energy balance -- quality improvement -- feeding protocols -- underfeeding; Parenteral feeding -- Periodicals; Enteral feeding -- Periodicals; 615.85484
• DOI: 10.1177/0148607116673301
• Languages: English
• ISSNs: 0148-6071

Abstract

Abstract: Background : The purpose of this study was to determine what was "best achievable practice" with the implementation of a novel enteral feeding protocol (Enhanced Protein‐Energy Provision via the Enteral Route Feeding Protocol [PEP uP protocol]). Methods : This study was a multicenter quality improvement collaborative wherein we describe nutrition practices and outcomes within PEP uP sites. We report the minimum, average, and maximal site‐level performance on aspects related to nutrition practices and outcomes. Results : In 2014, 7 intensive care units (ICUs) in the United States implemented the PEP uP protocol. On average, over the first 5 ICU days, patients received 35% (site range, 26%–53%) of their prescribed energy requirements and 42% (site range, 29%–66%) of their prescribed protein requirements from enteral nutrition. In PEP uP sites, 71% (site range, 58%–95%) of patients received a semidigested formula within 72 hours of admission to the ICU, 72% had a volume‐based goal as the initial feeding strategy (site range, 47%–100%), 56% had prophylactic protein supplements (site range, 0%–100%), and 19% received prophylactic motility agents (site range, 0%–85%). Conclusions : There was variable success with the implementation of the different components of the PEP uP protocol. Improving the implementation of the various components may further increase nutrition delivery.