Date of Award

Summer 2024

Project Type

Thesis

College or School

CHHS

Department

Nursing

Departments (Collect)

Nursing

Program or Major

Certified Nurse Leader

Degree Name

Master of Science

First Advisor

Deborah Simonton

Second Advisor

Pamela Kallmerten

Third Advisor

Jessica Dane

Abstract

The American Society for Enteral and Parenteral Nutrition (ASPEN) and the Society for Critical Care Medicine (SCCM) updated the Adult Patient Enteral Nutrition Guidelines in 2016. These updates included discontinuing routine gastric residual monitoring due to its contribution to poor patient outcomes and mentioning the lack of evidence proving its relevance to gastric motility. Per ASPEN and SCCM, best practice suggests monitoring patients for intolerance symptoms and then checking gastric residual volume (GRV) if symptoms are present. If the GRV is greater than 500ml and intolerance symptoms are present, the recommendation is to perform further assessment, potentially leading to stopping enteral nutrition. This quality improvement (QI) project identified a critical care microsystem lacking an official GRV protocol using a 5P assessment, resulting in inconsistencies in patient care. Evidence-based research using a PRISMA flow diagram showed that routine gastric residual monitoring can lead to the inappropriate cessation of enteral nutrition, resulting in poor patient outcomes such as malnutrition and longer hospital stays. This project aimed to implement best practices related to GRV in a critical care microsystem and improve staff knowledge by 30%. A nurse-driven GRV Protocol tool was created and evaluated by unit intensivists and dieticians. Education was provided to staff via PowerPoint education sessions. A knowledge, attitudes, and practices (KAP) survey assessed staff members’ pre- and post-GRV education and protocol implementation. Chart audits were performed a month before the protocol implementation and a month after to monitor the change and adoption of the GRV protocol. Per survey results, staff knowledge improved by 40% after the education sessions. Additionally, the GRV Protocol was enacted twice with successful patient outcomes. Implications for future practice involve creating self-sustaining education, surveying, and auditing processes for the QI project to become the parent study of a larger study that will contribute to the discussion of routine GRV monitoring evidence-based practice.

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