Title : Development and implementation of evidence-based quality improvement project for enteral nutrition in prone mechanically ventilated patients
Abstract:
Background: Available evidence suggests that enteral nutrition could not be delayed in patients with mechanical ventilation in a prone position. However, the incidence of malnutrition among patients undergoing ventilation in a prone position can reach up to 70%. Therefore, although enteral nutrition is essential for patients undergoing prone mechanical ventilation, evidence-based management protocols are deficient in clinical practice.
Aim: To develop an evidence-based enteral nutrition management protocol for patients undergoing prone mechanical ventilation, and implement the healthcare quality review and improvement project.
Methods: This was a before-and-after study. The enteral nutrition management protocol was developed based on quality evidence from the literature search. The healthcare quality review and improvement project mainly included a baseline investigation of all stakeholders (ICU healthcare workers and patients), improvement action and effectiveness evaluation. The knowledge, attitudes and behavior regarding enteral nutrition for patients undergoing prone mechanical ventilation, as well as the nutritional status of patients were compared before and after the improvement.
Results: A total of 3 guidelines, 3 evidence syntheses, 1 expert consensus, 2 literature reviews, and 3 randomized controlled studies were included in the best evidence. The enteral nutrition management protocol in patients undergoing prone mechanical ventilation was developed, including staffing and training, assessment, selection of feeding routes, initiation and interruption timing, monitoring, feeding regimens, and the use of substances (Figure1). The improvement action, including the establishment of a multidisciplinary research team, the implementation of an evidence-based enteral nutrition management protocol, and the routine evaluation of healthcare quality, was implemented. The attitudes of ICU healthcare workers regarding enteral nutrition for patients undergoing prone mechanical ventilation remained consistent before and after improvement action (28.21± 2.81 vs. 28.82±2.08, P = 0.265). However, there was a significant increase in both knowledge and behavior following the improvement action (knowledge: 59.37±12.35 vs. 82.46±15.76; behavior: 67.18±7.70 vs. 71.28±5.98, P < 0.05). The standard-reaching rate of serum albumin/serum prealbumin was increased significantly among patients undergoing prone mechanical ventilation before and after improvement action (8.7% vs. 29.7%, P< 0.05).
Conclusion: This evidence-based quality improvement project can enhance ICU healthcare workers’ knowledge, attitudes and behavior regarding enteral nutrition for patients undergoing prone mechanical ventilation and improve their nutritional status.
