Implementation strategy for the enteral nutrition of ICU patients

Background: Adequate nutritional management improves the clinical outcome of critically ill patients, while malnutrition leads to increased morbidity and mortality. Although numerous guidelines for the nutrition of the critically ill are available concrete advice on how to implement them in clinical practice is lacking. Aim of the study: Verification of our own standardised concept for enteral nutrition of intensive care patients. Methods: This observational study was conducted over a period of eighteen months in three intensive care units (ICUs). A major aspect of the strategy was the establishment of a 'Core Team Nutrition' that developed the treatment tool 'Algorithm Start and Increase Enteral Nutrition' for integration in the patient's electronic medical record (EMR), and instructed all ICU personnel on how to apply it. The link between the EMR and a quality management system enabled a continual bedside update by doctors and nursing staff of the current nutritional treatment. The guideline-based quality indicators (A) start enteral nutrition within 24 hours of admission, and (B) complete enteral nutrition on day 4 of admission were documented. Results: A total of N=20.891 patient data sets were analysed, including all patients hospitalised longer than 24 hours irrespective of contraindications for enteral nutrition. On all three ICUs adherence to the defined quality indicators increased within the observation period (ICU-A 40%, ICU-B 340/s, ICU-C 43%). Conclusion: The concept resulted in a notable improvement in the initiation and increase of enteral nutrition on the ICU. More studies are needed to establish to what extent this concept can implement further aspects of clinical nutrition.