Effect of an external visual cue on delivery of enteral nutrition in a university trauma/surgical/burn intensive care unit
Background: Enteral nutrition in the critically ill patient is interrupted for myriad reasons some of which include withholding for operations, diagnostic tests, high residuals, feeding tube displacements and routine care. We sought to determine if use of an external visual cue by nursing increases delivery of goal enteral nutrition (EN) from baseline during the first 7 days of ICU admission. Methods: After achieving IRB approval we retrospectively evaluated all trauma/surgical/burn intensive care unit (TSBICU) records from May 2012 through March 2013 for patients with more than 7 days in the TSBICU who received EN as their primary means of nutrition support. In the initial arm, we identified goal EN and determined the percentage EN delivered, calculated average Braden score during the first 7 days of admission as well as average ICU length of stay (LOS), and then compared those data to the post intervention group. Intervention consisted of a nursing-placed placard that cued staff to initiate or resume EN. Data were analyzed utilizing Shapiro-Wilk W test, standard t-test, Fishers exact test, and Wilcoxon rank sum test. Data were further stratified to test differences between burn patients and remaining ICU patients. Results: Compared to all TSBICU patients in the pre-intervention group (n = 50), those in the post-intervention group (N = 31) did not receive significantly more EN (47.3% vs. 39.5%; p = 0.10), did not experience a difference in ICU LOS (14.5 vs. 13 days; p = 0.94), and did not see changes in average Braden scores (12.4 vs. 13; p = 0.14). However, parceling out the burn patients (N = 11) vs. remaining ICU patients (N = 70) showed burn patients received significantly higher delivery of EN (58.8% vs. 42%; p = 0.011) and experienced longer ICU LOS (21 vs. 13 days; p = 0.044). There was no difference in average Braden scores between the two groups. Conclusion: This retrospective review failed to demonstrate statistical significance for the application of a nursing- placed placard to cue resumption or initiation of EN. Burn patients received significantly more EN and had longer ICU LOS compared to trauma/surgical ICU patients.
Enteral nutrition, tube feeding, visual cue, intensive care unit, critically ill
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