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Purpose: The purpose of this Evidence-based practice (EBP) project was to implement current guidelines related to gastric residual volume (GRV) assessments for monitoring of feeding intolerance.
Background: Metabolic support of patients is critical for the survival of critical illness and optimal recovery. Enteral nutrition is the preferred method of delivery, but its success is dependent upon the bedside clinician2. Current clinical practice guidelines do not support the practice of monitoring GRVs however2; greater than 98% of critical care nurses utilize GRV monitoring to assess for feeding intolerance1. In our urban Academic Level I Trauma Center nursing practice and electronic orders supported GRV monitoring.
Methods: Conducted a literature search to determine if there was new evidence to support or refute the 2016 Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient: Society for Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N). Collaborated with unit-based Registered Dietician to confirm the 2016 guidelines. Literature findings and educational PowerPoints were presented to the Critical Care Practice Council and the Organizational Practice Council. Concurrently education was disseminated to the Education Leadership Council which was translated organizationally.
Results: The shared governance committees identified barriers to adopting the EBP including provider orders prescribing GRV assessments. The committees recommended removing GRV orders for all patients receiving enteral nutrition. Information Technology modified the Electronic Medical Record by removing GRV monitoring from the order set. Anecdotally, the practice change was supported by nursing. The next steps include collaborating with hospital bioinformatics to obtain data on feeding intolerance as measured by the cessation of enteral feeds both pre and post-practice change.
Conclusion: Translation of EBP to the bedside is the most critical step in promoting positive patient outcomes. Despite clinical practice guidelines, often it is the system that perpetuates outdated clinical practice. In this EBP project, a modification to the EMR led to the cessation of a barrier towards the implementation of clinical practice guidelines.
This poster is distributed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) License (https://creativecommons.org/licenses/by-nc-nd/4.0/).
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