title: A practice change initiative to improve the provision of enteral nutrition to intensive care patients.
abstract: OBJECTIVE
  To describe a practice change initiative that improved the provision of enteral nutrition (EN) to patients in a New Zealand tertiary intensive care unit (ICU).
  
  
  METHODS
  The project reviewed and summarized EN literature, amended local policy, and an evidence-based EN delivery algorithm was developed. The EN practice change initiative was implemented and evaluated. Data was collected and analyzed in a pre-audit (2009) and a post-audit (2013).
  
  
  RESULTS
  Comparison of the pre-audit (N = 25) and the post-audit (N = 40) data demonstrated improvements in three areas of EN delivery. The commencement of early EN within 24 h of admission was evident for a large proportion of patients in both 2009 and 2013 audits. There was a large reduction in time between the two audits for both ICU admission to achievement of EN goal rate (M = 57·71 h versus M = 33·79 h, p = 0·006) and also for EN commencement to achievement of EN goal rate (M = 31·65 h versus M = 10·15 h, p = 0·000). The volume of prescribed EN delivered on days 2, 4 and 6 was greater in the 2013 audit in comparison to the 2009 audit. Staff compliance with adhering to the EN policy and algorithm improved from 46% in 2009, to 95% in 2013.
  
  
  CONCLUSIONS
  The practice change has significantly improved the practice delivery of EN for patients in the local ICU resulting in optimal care.
  
  
  CONCLUSIONS
  Malnutrition is highly prevalent among intensive care patients. Strategies and initiatives that improve the delivery of enteral nutrition to the critical care population is therefore vitally important. This article describing such an initiative is thus highly relevant to all health care professionals delivering enteral nutrition in intensive and critical care units.
authors.affiliation: AUT University, Auckland 1142, New Zealand.
authors.forename: Rebecca J
authors.initials: RJ
authors.lastname: Jarden
authors.affiliation: Intensive Care Unit, Wellington Regional Hospital, Wellington 6018, New Zealand.
authors.forename: Lynsey J
authors.initials: LJ
authors.lastname: Sutton
mesh_terms: D003422:Critical Care; D016638:Critical Illness; D004750:Enteral Nutrition / Q000592:standards; D055317:Evidence-Based Practice; D019983:Guideline Adherence; D006801:Humans; D044342:Malnutrition / Q000517:prevention & control; D009520:New Zealand; D012189:Retrospective Studies; D013997:Time Factors
keywords: Enteral nutrition; Gastric residual volumes; Intensive care; Literature review; Practice change