title: What Is "Best Achievable" Practice in Implementing the Enhanced Protein-Energy Provision via the Enteral Route Feeding Protocol in Intensive Care Units in the United States? Results of a Multicenter, Quality Improvement Collaborative.
abstract: The purpose of this study was to determine what was "best achievable practice" with the implementation of a novel enteral feeding protocol (Enhanced Protein-Energy Provision via the Enteral Route Feeding Protocol [PEP uP protocol]).
  
  
  
  This study was a multicenter quality improvement collaborative wherein we describe nutrition practices and outcomes within PEP uP sites. We report the minimum, average, and maximal site-level performance on aspects related to nutrition practices and outcomes.
  
  
  
  In 2014, 7 intensive care units (ICUs) in the United States implemented the PEP uP protocol. On average, over the first 5 ICU days, patients received 35% (site range, 26%-53%) of their prescribed energy requirements and 42% (site range, 29%-66%) of their prescribed protein requirements from enteral nutrition. In PEP uP sites, 71% (site range, 58%-95%) of patients received a semidigested formula within 72 hours of admission to the ICU, 72% had a volume-based goal as the initial feeding strategy (site range, 47%-100%), 56% had prophylactic protein supplements (site range, 0%-100%), and 19% received prophylactic motility agents (site range, 0%-85%).
  
  
  
  There was variable success with the implementation of the different components of the PEP uP protocol. Improving the implementation of the various components may further increase nutrition delivery.
authors.affiliation: Clinical Evaluation Research Unit, Kingston General Hospital, Kingston, Ontario, Canada.|Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada.|Department of Critical Care Medicine, Queen's University, Kingston, Ontario, Canada.
authors.forename: Daren K
authors.initials: DK
authors.lastname: Heyland
authors.affiliation: Clinical Evaluation Research Unit, Kingston General Hospital, Kingston, Ontario, Canada.
authors.forename: Margot
authors.initials: M
authors.lastname: Lemieux
authors.affiliation: Phoenix VA Health Care System, Arizona, USA.
authors.forename: Lin
authors.initials: L
authors.lastname: Shu
authors.affiliation: Medical University of South Carolina, Charleston, South Carolina, USA.
authors.forename: Kristen
authors.initials: K
authors.lastname: Quisenberry
authors.affiliation: Clinical Evaluation Research Unit, Kingston General Hospital, Kingston, Ontario, Canada.|Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada.
authors.forename: Andrew G
authors.initials: AG
authors.lastname: Day
mesh_terms: D002985:Clinical Protocols; D003299:Cooperative Behavior; D003422:Critical Care / Q000379:methods* / Q000592:standards; D004044:Dietary Proteins / Q000008:administration & dosage*; D002149:Energy Intake; D004750:Enteral Nutrition / Q000379:methods* / Q000592:standards*; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009751:Nutritional Requirements; D011446:Prospective Studies; D058996:Quality Improvement; D014481:United States
chemical_list: D004044:Dietary Proteins
keywords: caloric intake; critical care; energy balance; feeding protocols; nutrition status; nutrition therapy; quality improvement; underfeeding