Improving Nutritional Support of Burn Service Patients by Increasing the Number of Days When 100% of Prescribed Formula Is Given.
The authors sought to increase the number of days when burn service patients receive 100% of prescribed enteral nutrition. The authors first performed a retrospective review of 37 patients (group 1) receiving enteral nutrition. The authors then created and implemented a nurse-directed feeding algorithm, placing patients into three age groups addressing maximum hourly infusion rates, high residual limits, initiating feeding, refeeding residuals, and replacing formula. The authors then performed a prospective review of 37 patients (group 2) fed utilizing the new algorithm. The amount of prescribed, infused, discarded, and missed feeds were recorded, as well as admitting diagnosis, age, gender, length of stay, ventilator days, infections, and mortality. All patients in group 1 (n = 37) received 100% of feeds 59.9% of prescribed days vs 76.5% in group 2 (n = 37; P = .003). Burn patients in group 1 (n = 26) received 100% of feeds 61.6% of prescribed days vs 85.4% in group 2 (n = 21; P < .001). The mean amount of hours tube feeds were held for surgery, procedures, clogged or dislodged tubes, in both historical control and the group using the restorative algorithm were the same. While there was a significant difference in burn size between groups (6.24 vs 18.39%, P = .01), there were no statistically significant differences in length of stay, ventilator days, or mortality. Implementation of a nurse-directed feeding algorithm improved delivery of enteral nutrition for all burn service patients, increasing the number of days when 100% of prescribed enteral nutrition is given.
From the *Loyola University Health System Burn Center and Burn & Shock Trauma Research Institute, Maywood, IL; and † Department of Surgery, Loyola University Medical Center Stritch School of Medicine.
Peggie F
PF
Conrad
Julie
J
Liberio
Razia
R
Aleem
Marcia M
MM
Halerz
Michael J
MJ
Mosier
Arthur P
AP
Sanford
Neelam
N
Balasubramanian
Richard L
RL
Gamelli
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000465:Algorithms; D002056:Burns / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D002149:Energy Intake; D004750:Enteral Nutrition; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D057184:Practice Patterns, Nurses'; D012189:Retrospective Studies; D013997:Time Factors; D055815:Young Adult