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Increasing Time to Full Enteral Feeds in Hospitalized Children with Medical Complexity Experiencing Feeding Intolerance

Musial, Abigail
http://rave.ohiolink.edu/etdc/view?acc_num=ucin1617104772672061

Abstract Details

2021, MS, University of Cincinnati, Medicine: Clinical and Translational Research.
Background and Objectives: Children with medical complexity (CMC) have co-existing chronic conditions and resultant functional limitations that may lead to difficulty achieving adequate nutrition. Ineffective management of reeding intolerance, defined as the inability to achieve target enteral intake combined with symptoms consistent with gastrointestinal dysfunction, can exacerbate this issue. Our primary objective was to decrease median time from admission to goal feeds from 3.5 days to 2.5 days in CMC fed via gastrostomy and gastrojejunostomy tubes admitted for feeding intolerance. Methods: A multi-disciplinary team of nurses, nurse practitioners, pediatric residents, hospitalist and gastroenterology physicians, parents, and a dietitian conducted this local quality improvement project. Key drivers included: standardized approach to managing feeding intolerance, shared understanding of parental goals for their child’s feeds, timely delivery of formula to the bedside, and provider knowledge. Plan-do-study-act cycles included development of a standardized feeding algorithm, education of providers, correcting formula room misinformation, addressing physician ordering practices at admission, near-real time reminders and feedback. A run chart tracked the effect of interventions on median time to goal enteral feeds and median length of stay (LOS). Results: Over the course of 6 months, median time to goal enteral feeds for CMC fed via gastrostomy or gastrojejunostomy tubes decreased from 3.5 days to 2 days, meeting special cause variation, and this decrease has been sustained for 1 year. This change coincided with implementation of a standardized feeding intolerance management algorithm. There was no change in LOS. Conclusions: There was a temporal association between implementation of a standardized algorithm for CMC hospitalized with Feeding intolerance and decreased time to goal enteral feeds; LOS did not change. Future work will include incorporating the algorithm into electronic health record order sets and spread of the algorithm to other service lines in our institution that frequently care for CMC.
Patrick Ryan, Ph.D. (Committee Chair)
Amanda Schondelmeyer, M.D. (Committee Member)
28 p.
Surgery
Children with Medical Complexity; Feeding Intolerance; Quality Improvement; Hospital Medicine

Recommended Citations

Citations

  • Musial, A. (2021). Increasing Time to Full Enteral Feeds in Hospitalized Children with Medical Complexity Experiencing Feeding Intolerance [Master's thesis, University of Cincinnati]. OhioLINK Electronic Theses and Dissertations Center. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1617104772672061

    APA Style (7th edition)

  • Musial, Abigail. Increasing Time to Full Enteral Feeds in Hospitalized Children with Medical Complexity Experiencing Feeding Intolerance. 2021. University of Cincinnati, Master's thesis. OhioLINK Electronic Theses and Dissertations Center, http://rave.ohiolink.edu/etdc/view?acc_num=ucin1617104772672061.

    MLA Style (8th edition)

  • Musial, Abigail. "Increasing Time to Full Enteral Feeds in Hospitalized Children with Medical Complexity Experiencing Feeding Intolerance." Master's thesis, University of Cincinnati, 2021. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1617104772672061

    Chicago Manual of Style (17th edition)

ucin1617104772672061
236
© 2021, all rights reserved.
This open access ETD is published by University of Cincinnati and OhioLINK.
Release 3.2.12