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Initiation of Pre- and Post-operative Feeding in Gastrointestinal Patients at the Royal Adelaide Hospital: A best practice implementation project

Clover, Emma BSc, MND, APD

doi: 10.1097/01.JBI.0000419759.42703.67
Evidence in Action: Peer Reviewed Article

Background Gastrointestinal (GI) patients have a high risk of malnutrition. Evidence suggests pre-operative nutrition support in malnourished patients improves surgical outcomes. There is no advantage in keeping patients fasted after GI surgery, and early initiation of food intake or enteral feeding has been shown to be beneficial.

Aims/Objectives To improve initiation of pre- and post-operative nutrition support in GI patients at the Royal Adelaide Hospital in accordance with evidence-based recommendations.

Methods An organizational audit was conducted across three GI surgical units within the Center of Digestive Diseases using the Joanna Briggs Institute Practical Application of Clinical Evidence System (PACES) program. The Getting Research into Practice (GRIP) module was used to facilitate identification of barriers and implementation strategies. A follow-up audit was conducted to assess change in practice.

Results The baseline audit revealed two of three GI surgical units had successful protocols to facilitate best practice for post-operative nutrition support. Compliance with provision of oral supplements via nurses improved following the GRIP phase. The third surgical unit showed poor compliance with best practice which did not change following the GRIP phase. More time is required to assess whether strategies to improve pre-operative nutrition support in malnourished patients are successful.

Conclusions Two of three GI surgical units are achieving post-operative nutrition support in accordance with best practice guidelines. Attempts to implement change were unsuccessful with the third unit. Implementation strategies engaging nursing staff were successful. Additional positive outcomes from strategies implemented are expected to be seen in the longer term.

Correspondence Details Emma Clover, Department of Clinical Dietetics, Level 7 Emergency Block, Royal Adelaide Hospital, North Terrace SA 5000 Telephone: (08) 8222 5223 Fax: (08) 8222 Email:

© 2012 Lippincott Williams & Wilkins, Inc.
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