Nasal Bridling for the Improved Delivery of Enteral Nutrition

Abstract

Problem: Critically ill patients are at an increased risk for malnutrition and its adverse effects. Chart audits were conducted on a 22-bed, medical cardiovascular intensive care unit revealed that out of 44 included patients, 37 did not receive at least 80% of their recommended nutrition. After a root cause analysis was conducted, unintentional feeding tube dislodgement was identified as a major contributor to interruptions in tube feed delivery. Purpose: The purpose of this project was to increase the delivery of enteral nutrition to patients in the intensive care unit by implementing nasal bridles as the standard practice for securing nasogastric tubes. Methods: Implementation of nasal bridles as the standard securement of nasogastric tubes was supported through the integration of high-quality staff engagement through hands-on training opportunities, competency development, environment optimization, and clinical advancement incentive opportunities. All patients with nasogastric tubes and enteral nutrition orders for at least 24 hours were included in this quality improvement project. Every 24 hours, patient charts were audited for method of tube securement, and total enteral nutrition delivered compared dietician recommendations. Results: Baseline data collection indicated an average delivery of 44% of enteral nutrition requirements. During the last month of project implementation, the documented delivery of enteral nutrition improved to over 90%. Patients with nasogastric tubes secured with bridles, on average, received more enteral nutrition (88.5%) than those secured by adhesive or tape (70.8%). Lastly, 30 nasogastric tubes secured by adhesive or tape were dislodged compared to zero dislodged tubes secured by bridle over the course of this project. Conclusions: Nasal bridles are an effective method to reduce inadvertent tube dislodgement and increase the delivery of enteral nutrition in this medical cardiovascular intensive care unit.