Guideline recommendations and implementation strategies |
I am not familiar with our current guidelines for nutrition in the ICU. |
4.06±0.06 |
3.81±0.11 |
1.85 |
0.060 |
Current scientific evidence supporting some nutrition interventions is inadequate to inform practice. |
3.80±0.68 |
3.50±0.12 |
2.22 |
0.020 |
The language of the recommendations of the current guidelines for nutrition are not easy to understand. |
3.65±0.07 |
3.22±0.11 |
3.24 |
0.001 |
The current guidelines for nutrition are not readily accessible when I want to refer to them. |
3.95±0.06 |
4.31±0.12 |
–2.77 |
0.006 |
No feeding protocol in place to guide the initiation and progression of enteral nutrition |
4.04±0.06 |
4.34±0.12 |
–2.27 |
0.023 |
Current feeding protocol is outdated. |
3.94±0.06 |
3.46±0.13 |
3.62 |
0.001 |
ICU resources |
Not enough nursing staff to deliver adequate nutrition |
3.39±0.08 |
3.27±0.15 |
0.70 |
0.487 |
Enteral formula not available on the unit |
4.06±0.06 |
4.27±0.12 |
–1.57 |
0.117 |
No or not enough feeding pumps on the unit |
3.94±0.07 |
4.40±0.12 |
–3.09 |
0.002 |
Dietitian support |
Waiting for the dietitian to assess the patient |
3.98±0.06 |
4.43±0.61 |
–3.83 |
0.002 |
Dietitian not routinely present on weekday patient rounds |
3.95±0.06 |
4.60±0.05 |
–5.87 |
0.001 |
No or not enough dietitian coverage during evenings, weekends and holidays |
3.85±0.07 |
4.75±0.06 |
–7.10 |
0.001 |
Not enough time dedicated to education and training on how to optimally feed patients |
3.80±0.07 |
4.61±0.07 |
–6.41 |
0.001 |
Delivery of enteral nutrition to the patient |
Delay in physicians ordering the initiation of enteral nutrition |
3.77±0.06 |
2.57±0.12 |
9.10 |
0.001 |
Waiting for physician/radiology to read X-ray and confirm tube placement |
3.41±0.08 |
2.63±0.08 |
5.67 |
0.001 |
Frequent displacement of feeding tube, requiring reinsertion |
3.06±0.09 |
1.85±0.09 |
7.28 |
0.001 |
Delays in initiating motility agents in patients not tolerating enteral nutrition (i.e., high gastric residual volumes) |
3.71±0.07 |
3.76±0.09 |
–0.49 |
0.622 |
Delays and difficulties in obtaining small bowel access in patients not tolerating enteral nutrition (i.e., high gastric residual volumes) |
3.97±0.06 |
4.64±0.07 |
–6.86 |
0.001 |
In resuscitated, hemodynamically stable patients, other aspects of patient care still take priority over |
3.88±0.07 |
4.58±0.07 |
–6.61 |
0.001 |
Nutrition therapy not routinely discussed on patient care rounds |
3.81±0.07 |
4.45±0.07 |
–5.90 |
0.001 |
Critical care provider attitudes and behavior |
Non-ICU physicians (i.e., surgeons, gastroenterologists) requesting patients not be fed entirely |
3.39±0.07 |
2.15±0.14 |
7.55 |
0.001 |
Nurses failing to progress feeds as per the feeding protocol |
3.25±0.08 |
2.55±0.13 |
4.57 |
0.001 |
Feeds being held due to diarrhea |
3.69±0.06 |
4.31±0.05 |
–6.81 |
0.001 |
Fear of adverse events due to aggressively feeding patients |
3.58±0.07 |
4.22±0.06 |
–6.64 |
0.001 |
Feeding being held too far in advance of procedures or operating room visits |
3.96±0.07 |
4.71±0.06 |
–7.57 |
0.001 |
General belief among ICU team that provision of adequate nutrition does not impact on patient outcome |
3.25±0.08 |
2.04±0.09 |
9.90 |
0.001 |