Improving Nutrition for Patients with Severe Burns Utilizing a Nurse-Driven Volume-Based Enteral Feeding Protocol

Abstract

Proper nutrition is critical in all phases of healing burn wounds. The importance of nutritional support in severely burned patients is well documented, but the provision of adequate nutrition to this population is frequently suboptimal. Enteral nutrition helps to meet these nutritional goals. A nurse-driven volume-based feeding (VBF) approach focuses on the goal volume a burn patient receives in a 24-hour period. This initiative’s objective is to utilize a nurse-driven protocol to optimize the nutritional intake the severely burned patient receives. The purpose of the quality initiative was to improve successful utilization of VBF for hospitalized burn patients who require EN. Secondary objectives were to evaluate adoption and fidelity to the protocol. To meet these objectives, an electronic VBF protocol was activated within the EMR in a surgical intensive care unit for severely injured burn patients. Nursing staff were educated on the protocol and key components for reaching 80% of target nutritional values. Protocol adoption and fidelity were tracked among eligible patients for 10 weeks. Among the six severely burned patients admitted during the observation period; findings indicate a high utilization of the VBF protocol. This included 100% for ordering, 100% for documentation of required components, and 100% of patients meeting nutritional goals of 80%. Implementation of an electronic VBF protocol increased the number of patients who received target nutritional goals. Use of a standardized protocol, combined with education, auditing, and ongoing evaluation may be an effective method to align current practices with evidence-based recommendations.A three-year embargo was granted for this item