Page 188 - Hospital Authority Convention 2018

Parallel Sessions
HOSPITAL AUTHORITY CONVENTION 2018

PS11.1 Evidence Based Nursing 14:30 Room 221

Evidenced Based Practice: Advancing Practice and Improving Outcomes of Care
Dudley Brown S
Johns Hopkins School of Nursing, USA
Evidence based practice (EBP), one form of nursing inquiry, arms nurses with the knowledge to influence quality/safety/cost
of care, and can influence patient and organisational outcomes. Once EBP is integrated into the fabric of the organisation,
expect that both patient and nurse outcomes will be impacted. For the patient, they benefit by reducing nurse practice
variation, and utilisation of most up-to-date care. For the nurse, EBP increases their autonomy, strengthening their
clinical judgment, and can re-invigorate practice. This presentation will describe the impact of EBP on nurse, patient and
organisational outcomes, providing some examples of projects from the Johns Hopkins Hospital, Baltimore, MD, USA.

PS11.2 Evidence Based Nursing 14:30 Room 221

Optimisation of Enteral Nutrition in Intensive Care Units through an Evidence Based Approach
Chau LS
Intensive Care Unit, Tuen Mun Hospital, Hong Kong

Introduction
Tuesday, 8 May 2018 factors affect enteral nutrition (EN) and may be resulted in suboptimal nutritional support.
Nutritional support is essential for critically ill patients; and enteral feeding is currently considered the best option for
providing nutrition. However, inadequate enteral feeding continues to exist in intensive care units (ICU) worldwide. Many

Objectives
To develop an EN protocol that guides gastric residual volume (GRV) management; and (2) to minimise unnecessary
interruption of nutrition delivery.
Methodology
A workgroup was formed in January 2017. Members involved representatives from five local ICUs. EN protocol was
formulated according to Johns Hopkins Nursing Evidence Based Practice model. Alignment of practice across ICUs was
attempted.

Results and Outcomes
Practice in nutritional intake calculation, EN commencement rate, GRV assessment frequency, GRV cutoff value and use of
a prokinetic agent for intolerance were aligned across involved ICUs, but no consensus was reached for refeeding practice.
326 patients from a single ICU which piloted the protocol were studied (age=62.1±14.5; 74.8% mechanically ventilated; 56.7%
surgical patients; 66.2% male). 156 patients received EN according to doctor’s decision. 170 patients received EN according
to an interdisciplinary protocol. No statistically significant difference in demographic data, mean ICU length of stay (9.08 days
vs 8.11 days, P=0.50), mortality (18.0% vs 16.0%, p=0.64) and total EN delivery duration (6.82 days vs 5.43 days, p=0.29)
was found between patient groups. Mean duration from EN commencement to nutritional target was 2.06 days. Daily calorie
intake was similar between groups (18.03 vs 18.22, p=0.82). Both EN interruption due to high GRV and incidence of adverse
events dropped from 16.7% to 12.9% and 8.3% to 5.3% after protocol implementation respectively.

The result was comparable with those ICUs which are already adopting EN guidelines. Protocol-driven EN delivery and GRV
management can maintain nutritional target through a reduction in feeding interruption.

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