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A Clinical Nurse Specialist–Led Initiative to Reduce Deficits in Tube Feeding Administration for the Surgical and Trauma Populations

Bielewicz, Brady John, DNP, RN, CCRN, TCRN, CNRN, ACCNS-AG; George, Elisabeth, PhD, RN, CRRN-K; Gunn, Scott, MD, FCCM; Oroukin, Meredith, RD, LDN, CNSC; Ren, Dianxu, PhD, MD; Beach, Michael, DNP, ACNP-BC, PNP, FAAN; Tuite, Patricia, PhD, RN, CCNS

doi: 10.1097/NUR.0000000000000405
Feature Article

Purpose/Objectives: The purpose of this clinical nurse specialist–led initiative was to redefine the standard of care to reduce the deficit that exists between the daily amount of tube feedings prescribed versus received by patients in a surgical-trauma intensive care unit.

Description of the Project: Nutrition plays a vital role in health and wellness. Although nutritional recommendations are not always met by individuals on a daily basis—the presence of in-hospital malnutrition presents greater risks and complications after a surgery or traumatic event. An evidence-based algorithm for initiating and maintaining tube feedings was developed and incorporated into morning bedside report. A preintervention and postintervention chart analysis was done to calculate the amount of tube feedings received by patients during their first 5 days of admission.

Outcomes: Preintervention data revealed that 29 patients received a mean 49.8% (SD, 21.6%) of tube feedings prescribed, and postintervention data showed 31 patients received 60.4% (SD, 18.5%) of tube feedings prescribed (P = .04).

Conclusion: Through the implementation of a tube feeding algorithm, there was a reduction of tube feed interruptions and volume deficits during the first 5 days of admission.

Author Affiliations: Trauma Nurse Coordinator (Dr Bielewicz), Programmatic Nurse Specialist (Dr George), Medical Director of the Surgical and Trauma ICU (Dr Gunn), and Dietitian of Surgical and Trauma ICU (Ms Oroukin), UPMC-Presbyterian, Pittsburgh; and Associate Professor and Associate Director for Statistical Support (Dr Ren), Assistant Professor (Dr Beach), and Assistant Professor and Coordinator of the Clinical Nurse Specialist Area of Concentration (Dr Tuite), University of Pittsburgh, Pennsylvania.

The authors report no conflicts of interest.

Correspondence: Brady John Bielewicz, DNP, RN, CCRN, TCRN, CNRN, ACCNS-AG, UPMC-Presbyterian, 200 Lothrop Street, Pittsburgh, PA 15213 (

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