Factors influencing the implementation and adherence to volume-based enteral feeding protocols in the critical care setting: A scoping review
Bibliographic record
Abstract
OBJECTIVE: Delivery of enteral nutrition is an essential component of care for patients in the intensive care unit (ICU); however, patients only receive approximately 60% of prescribed enteral nutrition. Volume-based feeding (VBF) has been demonstrated as a safe and effective strategy to catch up for missed delivery of enteral nutrition. The aim of this review was to investigate factors influencing the adherence and implementation of VBF in the adult critical care and high-dependency unit settings to inform future implementation of VBF protocols in the ICU. METHODS: Systematic searches of databases (MEDLINE, EMBASE, and Emcare) and grey literature repositories (TROVE, TRIP, CPG Infobase, WorldCat, and Google) were conducted to identify original research studies including adults admitted to the ICU, where VBF or catch-up feeding protocols were in place. Studies reporting on barriers, enablers, and acceptability or adherence to VBF protocols were included. RESULTS: A total of 28 studies involving 7057 participants were eligible for inclusion, of which 19 were conducted in the USA, seven in Canada, one in the UK, and one in Australia. Factors enabling the implementation of VBF included management support, multidisciplinary team engagement, a project team, multimodal education, and communication strategies. Embedding the protocol into current work systems increased success. Barriers included a culture of deprioritising nutrition, safety concerns, staff turnover, and failure to embed the changes into work systems including the electronic medical record. VBF was considered acceptable to ICU staff; however, adherence to VBF protocols was variable (between 32.1% and 90%). CONCLUSION: Successful implementation of a VBF protocol is enabled by strong project leadership, staff education, team engagement, and embedding VBF into current work processes. VBF is acceptable to staff; however, continuous education is recommended to sustain change in practice. Implementation of VBF should be considered as part of an "enhanced" feeding strategy in the ICU setting. REGISTRATION: The protocol was developed and registered a priori on Open Science Framework on 8th August 2023 (https://doi.org/10.17605/OSF.IO/8DJKY).
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".