title: Adherence to a Nurse-Driven Feeding Protocol in a Pediatric Intensive Care Unit.
abstract: BACKGROUND
  Patients admitted to pediatric intensive care units (PICUs) often experience prolonged periods without nutrition support, which may result in hospital-induced malnutrition and longer length of stay. Nurse-driven feeding protocols have been developed to prevent unnecessary interruptions or delays to nutrition support. The primary objective of this study was to identify compliance and reasons for noncompliance to a feeding protocol at a tertiary care hospital PICU in Canada. The secondary aim was to determine the mean time (hours) spent without any form of nutrition and to identify reasons for time spent without nutrition.
  
  
  METHODS
  This was a prospective cohort audit, consisting of 150 consecutive PICU admissions (January-February 2016). Exclusion criteria consisted of patient mortality within 48 hours (n = 1) and patients who were still admitted at the end of the data collection timeframe (n = 7). The remaining cohort consisted of 142 consecutive admissions. Data collection took place in real time and included patient demographics, diagnostic categories, time spent without nutrition, reasons for interruptions to nutrition support, and reasons for noncompliance to the protocol. Observations were obtained through paper and computer charts and conversing with clinicians.
  
  
  RESULTS
  There was a 95% compliance rate to the protocol and an average of 25.6 hours spent without nutrition per patient. The most prevalent reason for noncompliance was an avoidable delay to restart feeds before/after procedures or after surgery.
  
  
  CONCLUSIONS
  A nurse-driven feeding protocol may reduce time spent without nutrition. Future research is required to examine the relationship between adherence to feeding protocols and clinical outcomes.
authors.affiliation: Division of Human Nutrition, Faculty of Agriculture, Life, and Environmental Sciences, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Carmen A
authors.initials: CA
authors.lastname: Cunningham
authors.affiliation: Division of Human Nutrition, Faculty of Agriculture, Life, and Environmental Sciences, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Lindsay B
authors.initials: LB
authors.lastname: Gervais
authors.affiliation: Division of Human Nutrition, Faculty of Agriculture, Life, and Environmental Sciences, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Vera C
authors.initials: VC
authors.lastname: Mazurak
authors.affiliation: Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Vijay
authors.initials: V
authors.lastname: Anand
authors.affiliation: Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Daniel
authors.initials: D
authors.lastname: Garros
authors.affiliation: Department of Epidemiology, School of Public Health, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Katelynn
authors.initials: K
authors.lastname: Crick
authors.affiliation: Division of Human Nutrition, Faculty of Agriculture, Life, and Environmental Sciences, University of Alberta, Edmonton, Alberta, Canada.|Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada.|Nutrition Services, Alberta Health Services, Edmonton, Alberta, Canada.
authors.forename: Bodil M K
authors.initials: BMK
authors.lastname: Larsen
mesh_terms: D002170:Canada; D002675:Child, Preschool; D002985:Clinical Protocols; D015331:Cohort Studies; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D008297:Male; D000072222:Nurses, Pediatric; D018529:Nutritional Support / Q000451:nursing* / Q000706:statistics & numerical data*; D010371:Pediatric Nursing / Q000379:methods*; D011446:Prospective Studies; D013997:Time Factors
keywords: adherence; critical care; enteral nutrition; feeding protocol; intensive care unit; pediatrics