Nutritional support of critically ill patients is an important aspect of critical care. The American Society of Parenteral and Enteral Nutrition (A.S.P.E.N.) and the Society of Critical Care Medicine have developed guidelines for enteral nutrition reflecting the latest evidence-based practice. The guidelines recommended early nutritional support, utilization of protocols, and enteral nutrition (EN) as the preferred choice of nutritional support. The Institute of Medicine also recommends utilization of evidence-based practice, guidelines, and protocols for health care delivery. Despite these recommendations, the Medical Intensive Care Unit (MICU) of a community based Magnet recognized hospital had not implemented the guidelines. Incidental observations noted during multidisciplinary rounds in the MICU and a performance improvement review found variability related to ordering and management of EN. These findings supported implementation of an evidence-based EN protocol. The project consisted of implementation of an EN order form and algorithm for management of gastric residual volumes (GRV). The objectives focused on clinical adherence, the amount of EN received, and the time frame that EN was temporarily discontinued. The objectives and outcomes of the study were related to clinician adherence, but the ultimate outcome was improved nutrition for the MICU patients.
