Multidisciplinary evaluation of a critical care enteral feeding algorithm

Aim: Feeding algorithms have been demonstrated to improve nutrition delivery and influence primary outcomes in critical care units. Most feeding algorithms assist decision-making related to initiation of enteral nutrition, use of prokinetics and the mode of delivery of feeding. The algorithm that is the subject of this evaluation enabled nursing staff to select type of feed and target feeding rate for enterally fed patients. The aims of this evaluation were to assess acceptance of the algorithm across disciplines, and to determine if energy and protein intakes achieved were comparable with data reported in an international multi-centre observational study. 

Methods: Semistructured interviews were conducted with eight nurses, three doctors and three dietitians, to gauge their attitudes towards usefulness of the algorithm. Data on energy and protein intakes was collected for 108 patients using nursing observation records of volume of feed delivered with deductions for discarded aspirates. 

Results: Positive feedback on usability of the algorithm was given by all interview participants. Common themes from the interviews were that the algorithm 'enabled feeding to start earlier', 'was simple to use' and 'ensured consistency of approach'. Greater than 80% of estimated nutritional targets were achieved, and enteral feeding commenced on average within 8hours. 

Conclusions: Evaluation of the new feeding algorithm indicated that it was well accepted by users, ensured a consistent approach to enteral feeding delivery and enabled feeding to start earlier within an intensive care unit.