Learning Objective #1: List evidence-based nursing practices related to safe, effective management of tube feedings

Learning Objective #2: Describe quality improvement educational strategies to introduce evidence-based protocols and change bedside nursing practices

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Background: Continuous quality improvement is a professional imperative. The diversity in levels of experience found in bedside clinicians in our institution prompted this project, seeking to improve the process of providing nutritional support to acutely and critically ill patients. The goals of this project were to 1) identify and correct knowledge deficits regarding nutrition support, 2) introduce a practice protocol for nutritional support of adults with acute and critical illnesses, and 3) evaluate the process improvement resulting from a focused educational program. Methods: A questionnaire was distributed to 100 ICU and Stepdown unit nurses to assess current behaviors related to the management of tube feedings. An educational intervention was developed to address the questionnaire responses and to introduce the practice protocol on participating units. A post-test was conducted to measure learning related to the educational intervention. Chart audits were conducted following the inservices to provide some indication that nurses have integrated the research-based protocol at a cognitive and practice level. Results: Forty –five completed questionnaires were returned for a 45% response rate. Seventy-five nursing staff members attended the educational intervention offered on 8 occasions. Twenty-two post-tests were returned, representing a 29% return rate. The post-test consisted of 14 questions specific to the content of the nutrition support practice protocol. All staff members who took the post-test achieved a passing score. An educational video was created for orientation of new staff. Chart audits supported the observation that documentation and clinical practice related to tube feedings have improved. Implications: The project has focused attention on sustaining high quality nursing care in an environment where nutrition support is an important step in the recovery of acute and critically ill patients. A practice protocol is crucial to standardizing processes of care in nursing units where there is high staff turnover and inexperienced new nurses.