Nursing staff adherence to guidelines on nutritional management for critically ill patients with cancer: A service evaluation.
Marie Parsons
PMID 38508155WHAT IT FOUND
Most patients in this ICU did not receive enteral nutrition within 48 hours, often because surgeons preferred parenteral feeding.
Nurses interrupted feeds for reasons not supported by guidelines. This is a service evaluation of one centre, not evidence of a treatment effect.
Key findings
0167% of the 64 patients analysed did not receive enteral nutrition within the first 48 hours of ICU admission, despite it being deemed appropriate.
02In 63% of the cases where early enteral nutrition was delayed or omitted, the documentation cited 'surgical/medical team preference'.
03Nurses interrupted continuous feeds for reasons not aligned with guidelines, including gastric residual volumes well below the threshold for stopping feed.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
This is a single-centre service evaluation, so the findings may not apply to other hospitals with different protocols or staff. The sample size was small (64 patients), and only a fraction of the eligible patients (211 out of 590) were screened. Data was collected retrospectively from notes, so missing or inaccurate documentation could skew the results. The qualitative part relied on a single focus group of five nurses, which may not represent the views of the whole unit. The author was a staff member on the unit, which raises concerns about objectivity despite steps taken to mitigate bias.
Declared interests
The authors declare no conflicts of interest.
The easy way to misread this
Do not interpret the low adherence rates as proof that enteral nutrition causes better outcomes in this specific population, as this paper did not measure patient outcomes like mortality or length of stay. It only reports how often guidelines were followed. The 'positive' direction refers to the identification of barriers, not a clinical benefit.