Paper
Sunday, November 13, 2005
Creation and Implementation of an Interdisciplinary Clinical Practice Guideline for Diet Advancement
Eileen Sacco, RN, BSN, CNRN, Clinical Services - 5B/5C, Lehigh Valley Hospital and Health Network, Allentown, PA, USA, Andrea Long, RN, BSN, Clinical Service 5B, Lehigh Valley Hospital, Allentown, PA, USA, and Lori A. Smith, RN, Clinical Services 5B, Lehigh Valley Hospital, Allentown, PA, USA.
| Learning Objective #1: Explore a multidisiciplinary approach to the creation, implementation and evaluation of clinical practice guidelines that impact length of stay and improve patient satisfaction |
| Learning Objective #2: Review an established medical management protocol that empowers nurses to facilitate early discharge to home with standardized diet advancement instructions |
Diet advancement has traditionally been determined by physician/nurse assessment of patient's tolerance of prescribed diet. Tolerance was determined by the presence of active bowel sounds without signs of increased abdominal distension, nausea, and/or vomiting. The progression and meaning of diet advancement varied among physicians and nurses resulting in inconsistent ordering of diets. In addition, patient discharges were often delayed until the patient was tolerating solid food. An interdisciplinary team, consisting of physicians, nurses, advanced practice nurses, a dietician, a pharmacist, and a care manager, was formed to investigate current practice related to diet advancement for surgical patients in one tertiary care facility. The goal of this initiative was to determine the relationship between diet advancement and length of stay. Multidisciplinary review of the evidence demonstrated that early initiation of liquid diet following abdominal surgery, independent of bowel sound presence, resulted in early discharge. In addition, several researchers concluded that use of a diet advancement protocol for discharge to home is effective and well tolerated by most patients. Based upon the evidence, guidelines were developed to facilitate diet advancement following a standardized medical management protocol based on a physician's initial order and the nurse's patient assessment. The team hypothesized that implementation of the guidelines would improve patient satisfaction through early discharge to home. A pilot study was conducted on one 32-bed medical/surgical unit to evaluate the efficacy of established guidelines prior to house-wide implementation. In conclusion, this presentation will further explore the creation, implementation and evaluation of clinical practice guidelines that impact length of stay, avoid delay in treatment, and improve patient satisfaction.