Attitudes to the delivery of enteral nutritional support to patients in British intensive care units.
OBJECTIVE
To assess the relative roles of medical, nursing and dietetic staff in the nutritional support of critically ill patients and the methods used to calculate energy requirements.


METHODS
Postal questionnaire.


METHODS
United Kingdom.


METHODS
Medical, nursing and dietetic staff of 289 hospitals with three or more intensive care beds.


RESULTS
Replies were received from 50.3% of participants. Doctors more commonly claimed responsibility for starting enteral nutrition (81.1%) although nurses and dietitians claimed a share of the decision in 28.6% and 11.4% of replies respectively.  Doctors claimed that they alone prescribed enteral nutrition in 52.8% of replies and with dietitians in 17.3% of cases whereas the dietitians claimed that they alone prescribed in 46.6% of replies and with doctors in 22.7%. Estimation was the commonest method used to assess patient energy requirements (68% of doctors, 59.5% of nurses and 51.1% of dietitians). Most respondents believed that this was adequate although not accurate.


CONCLUSIONS
There is evident confusion between medical, nursing and dietetic staff over responsibility for enteral nutrition.  Without a co-ordinated team approach advances in the enteral nutritional support of critically ill patients are unlikely.  Indirect calorimetry, an accurate predictor of an individual patient's energy requirements, has not gained widespread acceptance but will be necessary to tailor nutritional support to individual requirements.
Bloomsbury Department of Intensive Care Medicine, The Middlesex Hospital, London, UK.
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Adam
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Webb
D001291:Attitude of Health Personnel; D002153:Calorimetry, Indirect; D004750:Enteral Nutrition / Q000379:methods / Q000523:psychology; D006801:Humans; D007362:Intensive Care Units; D009741:Nursing Staff, Hospital; D015596:Nutrition Assessment; D010820:Physicians; D011795:Surveys and Questionnaires; D006113:United Kingdom