Implementing a Volume-based Feeding Protocol in the Neuroscience Critical Care Unit
AuthorGoularte, Vanlentina A.
AdvisorCosta, Linda L.
MetadataShow full item record
Other TitlesVBF Protocol in the NCCU
AbstractProblem and Purpose: Intensive care unit patients are at increased risk for hospital acquired malnutrition due to the stress of critical illness, inability to eat by mouth, and enteral feeding interruptions. At a large, urban, academic hospital in the neurological critical care unit (NCCU), sampling showed that only 62% of patients met their enteral nutrition (EN) goals. To address this gap in health care delivery, a volume-based feeding (VBF) protocol was implemented. Studies have shown that VBF protocols are safe and offer more effective nutritional delivery over rate-based protocols, which are the current standard of care. Methods: This is a pre/post intervention performance improvement study. An interdisciplinary approach was adopted and included a team of providers, nurses, and dietitians. A new policy was implemented by the unit to reflect the VBF protocol. Chart audits were conducted to determine baseline performance in EN delivery. Chart audits and data analysis were conducted again after education was completed and the protocol was initiated. Metrics being assessed were nursing and provider education rates, nursing and provider protocol compliance, and the amount of EN delivered daily over a seven-day period. Results: Comparing a total of 104 patients, 57 on a rate based feeding (RBF), were admitted prior to implementation of the VBF protocol and and 47 patients on the VBF protocol. In these groups there were 194 episodes of tube feedings (RBF=97, VBF=97). After 12 weeks of implementation of the VBF protocol, patients had more TF volume delivered and met their minimum volume goal more often compared to baseline data (VBF 82% vs. RBF 62%, p<0.005), and fewer, although not statistically significant episodes of hypoglycemia (VBF 1% vs RBF 4%, p=0.3), and feeding intolerance (VBF 34% vs. 37%, p=0.51). Provider and nursing staff compliance to the protocol were 74% and 68% respectively.
Keywordvolume-based feeding (VBF)