Factors influencing the implementation and adherence to volume-based enteral feeding protocols in the critical care setting: A scoping review

IF 2.6 3区医学 Q2 CRITICAL CARE MEDICINE

Australian Critical Care Pub Date : 2025-03-26 DOI:10.1016/j.aucc.2025.101209

Carolyn Hall MNutrDiet, APD , Sophie Page MNutDiet, APD , Noël Kelly NBSC, MDiet , Karthika Kardaris BNutDiet(Hons), APD , Lauren Hanna BNutrDiet, PhD, APD

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引用次数: 0

Abstract

Objective

Delivery of enteral nutrition is an essential component of care for patients in the intensive care unit (ICU); however, patients only receive approximately 60% of prescribed enteral nutrition. Volume-based feeding (VBF) has been demonstrated as a safe and effective strategy to catch up for missed delivery of enteral nutrition. The aim of this review was to investigate factors influencing the adherence and implementation of VBF in the adult critical care and high-dependency unit settings to inform future implementation of VBF protocols in the ICU.

Methods

Systematic searches of databases (MEDLINE, EMBASE, and Emcare) and grey literature repositories (TROVE, TRIP, CPG Infobase, WorldCat, and Google) were conducted to identify original research studies including adults admitted to the ICU, where VBF or catch-up feeding protocols were in place. Studies reporting on barriers, enablers, and acceptability or adherence to VBF protocols were included.

Results

A total of 28 studies involving 7057 participants were eligible for inclusion, of which 19 were conducted in the USA, seven in Canada, one in the UK, and one in Australia. Factors enabling the implementation of VBF included management support, multidisciplinary team engagement, a project team, multimodal education, and communication strategies. Embedding the protocol into current work systems increased success. Barriers included a culture of deprioritising nutrition, safety concerns, staff turnover, and failure to embed the changes into work systems including the electronic medical record. VBF was considered acceptable to ICU staff; however, adherence to VBF protocols was variable (between 32.1% and 90%).

Conclusion

Successful implementation of a VBF protocol is enabled by strong project leadership, staff education, team engagement, and embedding VBF into current work processes. VBF is acceptable to staff; however, continuous education is recommended to sustain change in practice. Implementation of VBF should be considered as part of an “enhanced” feeding strategy in the ICU setting.

Registration

The protocol was developed and registered a priori on Open Science Framework on 8th August 2023 (https://doi.org/10.17605/OSF.IO/8DJKY).

查看原文本刊更多论文

影响在重症监护环境中实施和遵守基于量的肠内喂养方案的因素：范围审查

目的肠内营养是重症监护病房（ICU）患者护理的重要组成部分；然而，患者只接受了约60%的规定肠内营养。以体积为基础的喂养（VBF）已被证明是一种安全有效的策略，可以弥补肠内营养的缺失。本综述的目的是调查影响成人重症监护和高依赖病房VBF依从性和实施的因素，为未来在ICU实施VBF方案提供信息。方法系统检索数据库（MEDLINE， EMBASE和Emcare）和灰色文献库（TROVE， TRIP, CPG Infobase， WorldCat和谷歌），以确定原始研究，包括ICU住院的成人，其中VBF或补饲方案已实施。研究报告了VBF协议的障碍、促成因素和可接受性或依从性。结果共有28项研究纳入7057名受试者，其中19项在美国进行，7项在加拿大进行，1项在英国进行，1项在澳大利亚进行。实现VBF的因素包括管理支持、多学科团队参与、项目团队、多模式教育和沟通策略。将协议嵌入到当前的工作系统中提高了成功率。障碍包括不重视营养的文化、安全问题、员工流失以及未能将这些变化纳入包括电子病历在内的工作系统。ICU工作人员认为VBF是可接受的；然而，VBF协议的依从性是可变的（在32.1%到90%之间）。VBF协议的成功实施需要强有力的项目领导、员工教育、团队参与以及将VBF嵌入当前的工作流程中。员工可以接受VBF；然而，建议继续教育以维持实践中的变化。VBF的实施应被视为ICU环境中“强化”喂养策略的一部分。该协议于2023年8月8日在开放科学框架（https://doi.org/10.17605/OSF.IO/8DJKY）上开发并先验注册。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Australian Critical Care NURSING-NURSING

CiteScore

4.90

自引率

9.10%

发文量

148

审稿时长

>12 weeks

期刊介绍： Australian Critical Care is the official journal of the Australian College of Critical Care Nurses (ACCCN). It is a bi-monthly peer-reviewed journal, providing clinically relevant research, reviews and articles of interest to the critical care community. Australian Critical Care publishes peer-reviewed scholarly papers that report research findings, research-based reviews, discussion papers and commentaries which are of interest to an international readership of critical care practitioners, educators, administrators and researchers. Interprofessional articles are welcomed.