Nutrition support practices in the intensive care unit of a tertiary hospital in Ghana
Article Sidebar
Main Article Content
Abstract
Background. Nutrition support is recognised as an important therapy for attenuating the catabolic effects of critical illnesses, including malnutrition prevention. However, variations in nutrition support practices make it difficult to achieve optimal outcomes in the intensive care unit (ICU).
Objectives. To explore current nutrition support practices among healthcare professionals (doctors and nurses) in the ICU of a tertiary hospital in Ghana.
Methods. Via a cross-sectional survey, the nutrition support practices and self-reported skills of 30 ICU healthcare professionals (23 nurses and 7 doctors) providing nutrition support were explored. Results are presented as themes with frequencies and proportions. Categorical data were analysed using Fisher’s exact test. Statistical significance was set at p<0.05.
Results. Most of the respondents were young and had limited ICU experience. Almost half of the respondents were unaware of or were not familiar with the content of an in-house feeding protocol for both enteral nutrition (EN) and parenteral nutrition support, despite a majority reporting the feeding protocol as the main source of nutrition support information. There was a general lack of standardisation of execution of most nutrition support practices, especially with the pattern of EN delivery, usual method of optimising EN, and gastric residual volume threshold used to guide practice. Most respondents self-reported being average/satisfactory in the management of nutrition support.
Conclusion. The study revealed that healthcare professionals in our ICU had varying nutrition support practices and competencies. There is a need for standardised and practical feeding protocols in accessible formats, ongoing education, and training in nutrition support to improve nutrition support practices and competencies of healthcare professionals providing nutrition support in the ICU setting.
Article Details
Issue
Section
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Authors retain copyright and grant the journal right of first publication.
How to Cite
References
ChowdhuryR,LobazS.Nutritionincriticalcare.BJAEduc2019;19(3):90-95.https://doi.org/10.1016/j. bjae.2018.11.007
Ferrie S, McWilliam D. Failure of a quality improvement process to increase nutrition delivery to intensive care patients. Anaesth Intensive Care 2006;34(2):191-196. https://doi. org/10.1177/0310057x0603400211
Hill A, Elke G. Nutrition in the intensive care unit — a narrative review. Nutrients. 2021;13(2851):1- 26. https://doi.org/10.1186/cc360
Roynette CE, Bongers A, Fulbrook P, Albarran JW, Hofman Z. Enteral feeding practices in European ICUs: A survey from the European federation of critical care nursing associations (EfCCNa). e-SPEN 2008;3(2). https://doi.org/10.1016/j.eclnm.2007.10.004
Hill LT. Nutrition support practices in South African ICUs: Results from a nationwide pilot survey. South Afr J Crit Care 2015;31(2):42-50. https://doi.org/10.7196/SAJCC.2015.v31i2.252
Gentles E, Mara J, Diamantidi K, et al. Delivery of enteral nutrition after the introduction of
practice guidelines and participation of dietitians in pediatric critical care clinical teams. J Acad
Nutr Diet 2014;114(12):1974-1980.e3. https://doi.org/10.1016/j.jand.2014.04.027
Heyland DK, Schroter-Noppe D, Drover JW, et al. Nutrition support in the critical care setting: current practice in Canadian ICUs--opportunities for improvement? J Parenter Enter Nutr 2003
;27(1):74-83. https://doi.org/10.1177/014860710302700174
Yang L, Dong Z. Adherence to guidelines on nutritional support by medical residents in an
intensive care unit in China: A prospective observational study. Med Sci Monit 2019;25:8645-
https://doi.org/10.12659/MSM.917684
Jones NE, Suurdt J, Ouelette-Kuntz H, Heyland DK. Implementation of the Canadian Clinical
Practice Guidelines for Nutrition Support: A multiple case study of barriers and enablers. Nutr
Clin Pract 1;22(4):449-457. https://doi.org/10.1177/0115426507022004449
Marshall BAP, Cahill NE, Gramlich L, Macdonald G, Alberda C, Heyland DK. Optimizing nutrition in intensive care units: Empowering critical care nurses to be effective agents of change.
Am J Crit Care 2012;21(3):186-194. https://doi.org/10.4037/ajcc2012697
Abban PKY. Nutrition support practices in Ghanaian hospitals. University of Ghana; 2020. https://
ugspace.ug.edu.gh/handle/123456789/35926
Wickham H, Averick M, Bryan J, et al. Welcome to the Tidyverse. J Open Source Softw 2019;4(43):1686. https://doi.org/10.21105/joss.01686
Critical Care Nutrition. 2015 Canadian Clinical Practice Guidelines. https://www. criticalcarenutrition.com/resources/cpgs/past-guidelines/2015. (accessed 31 January 2020).
McClave SA, Taylor BE, Martindale RG, et al. Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.). J Parenter Enter Nutr 2016;40(2):159-211. https://doi.org/10.1177/0148607115621863
Zusman O, Theilla M, Cohen J, Kagan I, Bendavid I, Singer P. Resting energy expenditure, calorie and protein consumption in critically ill patients: A retrospective cohort study. Crit Care 2016;20(1):1-8. https://doi.org/10.1186/s13054-016-1538-4
Singer P, Blaser AR, Berger MM, et al. ESPEN guideline on clinical nutrition in the intensive care unit. Clin Nutr 2019;38(1):48-79. https://doi.org/10.1016/j.clnu.2018.08.037
Niv E, Fireman Z, Vaisman N. Post-pyloric feeding. World J Gastroenterol 2009;15(11):1281- 1288. https://doi.org/ 10.3748/wjg.15.1281
Blaser AR, Starkopf J, Alhazzani W, et al. Early enteral nutrition in critically ill patients: ESICM clinical practice guidelines. Intensive Care Med 2017;43(3):380-398. https://doi.org/ 10.1007/ s00134-016-4665-0
Cahill NE, Suurdt J, Ouellette-Kuntz H, Heyland DK. Understanding adherence to guidelines in the intensive care unit: Development of a comprehensive framework. J Parenter Enter Nutr 2010;34(6):616-624. https://doi.org/ 10.1177/0148607110361904
Dodek P, Cahill NE, Heyland DK. The relationship between organisational culture and implementation of clinical practice guidelines: A narrative review. Knowl Transl 2018;34(6):6669- 6674. https://doi.org/10.2307/j.ctv5vdf1q
Cahill NE, Dhaliwal R, Day AG, Jiang X, Heyland DK. Nutrition therapy in the critical care setting: What is “best achievable” practice? An international multicenter observational study. Crit Care Med 2010;38(2):395-401. https://doi.org/10.1097/CCM.0b013e3181c0263d
Ayande REA, Agordoh PD, Salino VJ, et al. Knowledge, attitudes, and practices of registered dietitians and nutritionists regarding enteral and parenteral nutrition support in Ghana: A needs assessment study. Front Nutr 2023;10(June):1-10. https://doi.org/10.3389/fnut.2023.1197610
Sharifi MN, Walton A, Chakrabarty G, Rahman T, Neild P, Poullis A. Nutrition support in intensive care units in England: A snapshot of present practice. Br J Nutr 2011;106(8):1240-1244. https://doi.org/10.1017/S0007114511001619
Fulbrook P, Bongers A, Albarran JW. A European survey of enteral nutrition practices and procedures in adult intensive care units. J Clin Nurs 2007 1;16(11):2132-2141. https://doi. org/10.1111/j.1365-2702.2006.01841.x
Guenter P, Blackmer A, Malone A, Phillips W, Mogensen KM, Becker P. Current nutrition assessment practice: A 2022 survey. Nutr Clin Pract 2023;1-11. https://doi.org/10.1002/ncp.10998 26. Ramuada L, Veldsman L, Livhuwani N, Blaauw R. Assessment of knowledge, attitude and practice of nurses regarding enteral nutrition at a military hospital. South Afr J Clin Nutr 2023;36(2):63-69.
https://doi.org/10.1080/16070658.2022.2076970
Sinuff T, Cahill NE, Dhaliwal R, Miao Wang, Day AG, Heyland DK. The value of audit and feedback reports in improving nutrition therapy in the intensive care unit: A multicenter observational study. J Parenter Enter Nutr 2010;34(6):660-668. https://doi.org/10.1177/0148607110373484