儿科重症监护病房护士主导喂养方案的依从性
护士主导喂养方案可预防儿科重症监护病房（PICU）患儿不必要的营养支持中断及延迟情况发生，从而降低院内营养不良发生率，缩短住院时间。
为此，加拿大斯托勒里儿童医院、阿尔伯塔大学开展了一项前瞻研究，入组PICU患儿149例。
结果发现，该方案依从率达95%，主要的非依从原因有：可避免的操作或手术前后重新开始喂养延迟（34%）、意识到却未干预（23%）、害怕造成损伤（20%）等。与实施方案前的数据对比发现，实施护士主导喂养方案的患儿无营养支持时间比从40%下降到26%。
JPEN J Parenter Enteral Nutr. 2017;41(2):290-291.
Adherence to a nurse-driven feeding protocol in a pediatric intensive care unit.
Bodil Larsen; Lindsay Gervais; Carmen Cunningham; Vera Mazurak; Vijay Anand; Daniel Garros.
Stollery Children's Hospital, Edmonton, Alberta, Canada; University of Alberta, Edmonton, Alberta, Canada.
Purpose: Patients admitted to pediatric intensive care units (PICUs) often experience prolonged periods without nutrition support, which may result in hospital-induced malnutrition and longer length of stay. Nurse-driven feeding protocols have been developed to prevent unnecessary interruptions or delays to nutrition support. The primary objective of this study was to identify both compliance and the reasons for noncompliance to a feeding protocol in PICUs at a tertiary care hospital in Canada. The secondary objective was to compare results to a previous study in the same units, to determine if feeding practices have improved since the protocol was implemented.
Methods: This was a prospective cohort audit consisting of 149 consecutive PICU admissions (January-February 2016). Patient mortality within 48 hours was criteria for exclusion (n = 1). Data were collected daily from paper and computer charts as well as verbal communication with pediatric critical care providers and included patient demographics, diagnostic categories, time spent without nutrition, reasons for interruptions to nutrition support, and reasons for noncompliance to the feeding protocol. Descriptive statistics were used to characterize the study cohort, and a 1-way analysis of variance was performed to assess differences in nutrition initiation and interruptions within groups for our patient cohort. Pairwise independent t tests were performed for any groups with a significant P value. Chi-squared tests and proportion tests were used to compare the 2 cohorts (2012 vs 2016) for categorical variables. Independent t tests with P < .05 as significance were performed to compare the 2 cohorts for continuous variables.
Results: There was a 95% compliance rate to the protocol, with 35 incidences of noncompliance out of 690 total patient days. The most common reason for noncompliance was an avoidable delay to restart feeds before/after a procedure, or after surgery (34%). This was followed by awareness but no intervention (23%) and fear of doing harm (20%). Compared with preprotocol data, there was a significant reduction in mean time spent without nutrition, from 40% to 26%.
Conclusions: It is essential that the whole team is familiar with protocols and standards of practice. A nurse-driven feeding protocol may reduce the time spent without nutrition. Future research is required to examine the relationship between adherence to feeding protocols and clinical outcomes.
DOI: 10.1177/0148607116686023