Journal Article

472 A Fifteen Month Perspective on Achieving Early Enteral Nutrition in Burn Patients

M A Turner, S J Johnson and N M Kopari

in Journal of Burn Care & Research

Volume 39, issue suppl_1, pages S209-S209
Published in print April 2018 | ISSN: 1559-047X
Published online April 2018 | e-ISSN: 1559-0488 | DOI: http://dx.doi.org/10.1093/jbcr/iry006.394
472 A Fifteen Month Perspective on Achieving Early Enteral Nutrition in Burn Patients

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  • Medicine and Health
  • Acute Medicine
  • Emergency Medicine
  • Critical Care
  • Surgery

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Abstract

Introduction

Severe burn injury causes significant elevations in metabolic rate, resulting in increased nutritional needs. Early enteral nutrition in burn victims has shown lower incidence of complications. According to the American Society for Parenteral and Enteral Nutrition guidelines, initiating enteral nutrition is suggested to be within 4–6 hours of a burn injury. Our hospital policy is to receive enteral nutrition within 12 hours of admission. Multiple barriers can inhibit receiving early enteral nutrition. The purpose of this quality improvement project was to identify these barriers and systems to address those barriers.

Methods

A retrospective electronic chart review of adult and pediatric burn patients was conducted between May 1, 2016 and July 31, 2017. Inclusion criteria for starting early enteral nutrition were adults with ≥ 20% total body surface area (TBSA) burn and pediatric patients with ≥ 15% TBSA burn, or with inhalation injury requiring intubation. Data collection included age, gender, % TBSA burn, and time from admission to start of enteral nutrition. Primary outcome measure was percent of patients not receiving enteral nutrition within 12 hours of admission. Secondary outcome were the reasons for delays. Descriptive statistical analysis was conducted.

Results

Thirty-six patients were reviewed with an average age of 46.5 ± 22.7 years and 33.3 ± 22.7% TBSA burn. There were 47% of patients who did not receive enteral nutrition within 12 hours of admission. The most common reason for delay was difficult post-pyloric feeding tube placement, occurring in 53% of those patients. The second most common reason was late physician consults for enteral nutrition, occurring in 18% of patients. Other barriers included acuity level of severe burn patients, nursing turnover, dietitians not staffed 24 hours to place feeding tubes and enter orders, anticipated extubation by physician, and tube feeds not started due to surgery.

Conclusions

There are several reasons why early enteral nutrition was not achieved, with systems identified to counteract delays. These systems included: adequate and routine training of dietitians and nurses to place post-pyloric feeding tubes at bedside, creating nurse and physician nutrition champions and attendance to biweekly, multidisciplinary burn rounds. Data collection and analysis can be used to monitor these barriers and the successes of the implemented systems.

Applicability of Research to Practice

Now that barriers to achieving early enteral nutrition have been identified, we can move towards the goal of feeding 100% of patients with severe burn injury within 12 hours of admission. Furthermore, this will move us closer to the recommended guideline of starting enteral nutrition within 4–6 hours of injury.

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Subjects: Medicine and Health ; Acute Medicine ; Emergency Medicine ; Critical Care ; Surgery

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