| Description |
Procedures performed at the bedside such as bronchoscopy or transesophogeal echocardiogram (TEE) are common in the intensive care unit (ICU). These procedures, among others, require a prior period of fasting. Currently, common practice is to order "nil per os (NPO) at midnight", similar to practice still used in elective surgery cases. The identified gap in practice is that current guidelines and common practice do not account for critical illness, hypercatabolism, or enteral feedings via feeding tube. The critically ill patient is at a markedly increased risk for malnutrition. Malnutrition has been associated with poorer patient outcomes including increased risk of infection, increased ICU length of stay, increased hospital length of stay, increased readmission rates, and associated increased costs (Lew et al, 2016; Lim et al 2013; Philipson et al, 2013). It has also been estimated that malnutrition costs $157 billion annually in the United States (Snider et al, 2014). With these numbers in mind, malnutrition prevalence is estimated in 30-50% of patients admitted to the hospital (Snider et al, 2014), and that 56% of ICU patients have non-specific malnutrition (Mogensen et al, 2015). Beyond the relevant issues of cost, current literature and recommendations simply do not support the practice of prolonged fasting prior to bedside procedures and demonstrate an extreme paucity of evidence concerning enteral feedings. Essentially, critical illness causes a state of increased metabolism, which leads to greater risk of malnutrition, which in turn compounds disease severity and impedes the body's ability to heal. No current standardized guideline exists for fasting prior to bedside procedures in this patient population in a local tertiary hospital ICU. This project is to develop a guideline by combining current recommendations from the American Society of Anesthesiologists (ASA) and the American Society of Parenteral and Enteral Nutrition (A.S.P.E.N.) and tailoring it to the needs of this patient population. The guideline will be trialed in the Respiratory ICU. It will aim to improve nursing and medical staff's knowledge on current fasting recommendations, which will lead to improved patient care and outcomes. The objectives of this project will be achieved by 1) developing a pre-procedural fasting guideline and flowchart, 2) presenting the guideline and flowchart to key stake holders such as the medical director and unit management, 3) presenting an education piece to medical staff on current fasting and nutritional recommendations, 4) implementing a trial of the guideline and flowchart in the ICU, and 5) disseminating project findings by preparing an abstract for presentation at an appropriate conference. |
