Care of patients with enteral feeding tubes often is based on tradition and textbook guidance rather than best evidence. Care practices can vary widely both between and within institutions, and this was the case at a northeastern military medical center that served as the site for this evidence-based protocol development and implementation project.
The purpose of this study was to describe the development and implementation of an evidence-based clinical protocol for care of patients with enteral feeding tubes.
This was an evidence-based implementation project with pretest-posttest measures. Protocol data collection occurred both before and after implementation of the protocol. Data collection tools were based on the literature review and included three domains: (a) documentation of patient procedures, (b) nursing knowledge of each of the specific procedures, and (c) environment of care. Descriptive statistics and data were analyzed using independent samples t tests.
Overall staff knowledge of enteral feedings and methods used to unclog both large- and small-bore feeding tubes differed significantly before and after implementation (p< .05). Staff knowledge regarding the danger of using blue dye in feeding solution was significant (p < .001). There was improvement also in administration of medications separately rather than mixed together and in head of bed elevation of patients with feeding tubes. There was a 10% improvement in documentation of patient family education and a 15% improvement in recording fluid flushes during medication administration. After implementation, environment of care data collection showed 100% of patients with head of bed elevated and with functioning suction available, an improvement over levels before implementation.
Care must be taken in the interpretation of these findings because it was generally not the same nurses who answered both surveys. High staff turnover within this military hospital also affected sustainment of the protocol implementation. Maintenance activities must be constant and visible within the organization. A champion for evidence-based practice greatly enhances uptake and maintenance of nursing practice change.
Deborah J. Kenny, LTC, AN, USA, PhD, RN, is Executive Director, TriService Nursing Research Program, Uniformed Services University of the Health Sciences, Bethesda, Maryland.
Petra Goodman, COL, AN, USA, PhD, RN, is Assistant Chief, Nursing Research Service, Walter Reed Army Medical Center, Washington, DC.
Accepted for publication August 3, 2009.
Funding support was provided for this project by the TriService Nursing Research Program, MDA905-02-1-TS16, N02-P18; Principal Investigator: Patricia Watts Kelley. The Uniformed Services University of the Health Sciences (USUHS), 4301 Jones Bridge Rd., Bethesda, MD 20814-4799, is the awarding and administering office.
This project was sponsored by the TriService Nursing Research Program, Uniformed Services University of the Health Sciences; however, the information or content and conclusions do not necessarily represent the official position or policy of, nor should any official endorsement be inferred by, the TriService Nursing Research Program, Uniformed Services University of the Health Sciences, the Department of Defense, or the U.S. Government.
The views and opinions expressed in this article are solely those of the authors and do not reflect the policy or position of the Department of the Army, the Department of Defense, or the U.S. Government.
Corresponding author: Deborah J. Kenny, LTC, AN, USA, PhD, RN, 350 S. Clinton St. Apt 1D, Denver, CO 80247 (e-mail: firstname.lastname@example.org).