Abstract
Background: The purpose of this study was to determine what was “best achievable practice” with the implementation of a novel enteral feeding protocol (Enhanced Protein-Energy Provision via the Enteral Route Feeding Protocol [PEP uP protocol]). Methods: This study was a multicenter quality improvement collaborative wherein we describe nutrition practices and outcomes within PEP uP sites. We report the minimum, average, and maximal site-level performance on aspects related to nutrition practices and outcomes. Results: In 2014, 7 intensive care units (ICUs) in the United States implemented the PEP uP protocol. On average, over the first 5 ICU days, patients received 35% (site range, 26%–53%) of their prescribed energy requirements and 42% (site range, 29%–66%) of their prescribed protein requirements from enteral nutrition. In PEP uP sites, 71% (site range, 58%–95%) of patients received a semidigested formula within 72 hours of admission to the ICU, 72% had a volume-based goal as the initial feeding strategy (site range, 47%–100%), 56% had prophylactic protein supplements (site range, 0%–100%), and 19% received prophylactic motility agents (site range, 0%–85%). Conclusions: There was variable success with the implementation of the different components of the PEP uP protocol. Improving the implementation of the various components may further increase nutrition delivery.
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