Nursing Staff Adherence to National and International Guidelines on Nutritional Management for Critically Ill Patients With Cancer: A Service Evaluation, 2019

Parsons, Marie (2023). Nursing Staff Adherence to National and International Guidelines on Nutritional Management for Critically Ill Patients With Cancer: A Service Evaluation, 2019. [Data Collection]. Colchester, Essex: UK Data Service. 10.5255/UKDA-SN-856513

Aim and objectives: Critically ill patients with cancer are at high risk of developing malnutrition, negatively affecting their outcome. This service evaluation aims to critically analyse nursing staff's adherence to nutrition management guidelines for critically unwell patients with cancer and identify barriers which prevent this. Two areas of nutrition management were evaluated: early initiation of enteral nutrition (<48hrs from admission) (EN); and continuation of EN without interruption. Methods: A retrospective data analysis was performed in 2019 on mechanically ventilated adult patients admitted to a single cancer centre ITU between February 2017 to December 2018. Data from patient records concerning these three areas of nutrition management was collected. Healthcare professionals' (HCP) documentation was analysed, and a nursing staff focus group was undertaken. Results: Sixty-four patient records were included. Early EN was not administered in 67% (n=43) of cases. The reasons for the three longest interruptions to EN feed were as follows: delays in enteric feeding tube insertion, gastric residual volumes <500ml/6 hours and patient intubation. Four main themes relating to barriers in practice were identified from the focus group data analysis: HCPs' approach towards nutrition management, patient's physiological condition and stability, multi-disciplinary team communication and guidance on nutrition management and practical issues with patient care. Conclusions: Barriers in practice include inaccurate opinions and inadequate awareness on the importance of nutrition, multi-disciplinary communication difficulties and lack of clear recommendations set out by guidelines. Nursing education on the importance of optimal nutrition management is fundamental for this to improve. Results from this service evaluation can be used to improve practice in this unit. A further study with a greater number of cases incorporating views from the wider range of MDT members would be beneficial to determine the validity of these findings.

Data description (abstract)

Aim and objectives: Critically ill patients with cancer are at high risk of developing malnutrition, negatively affecting their outcome. This service evaluation aims to critically analyse nursing staff's adherence to nutrition management guidelines for critically unwell patients with cancer and identify barriers which prevent this. Two areas of nutrition management were evaluated: early initiation of enteral nutrition (<48hrs from admission) (EN); and continuation of EN without interruption. Methods: A retrospective data analysis was performed in 2019 on mechanically ventilated adult patients admitted to a single cancer centre ITU between February 2017 to December 2018. Data from patient records concerning these three areas of nutrition management was collected. Healthcare professionals' (HCP) documentation was analysed, and a nursing staff focus group was undertaken. Results: Sixty-four patient records were included. Early EN was not administered in 67% (n=43) of cases. The reasons for the three longest interruptions to EN feed were as follows: delays in enteric feeding tube insertion, gastric residual volumes <500ml/6 hours and patient intubation. Four main themes relating to barriers in practice were identified from the focus group data analysis: HCPs' approach towards nutrition management, patient's physiological condition and stability, multi-disciplinary team communication and guidance on nutrition management and practical issues with patient care. Conclusions: Barriers in practice include inaccurate opinions and inadequate awareness on the importance of nutrition, multi-disciplinary communication difficulties and lack of clear recommendations set out by guidelines. Nursing education on the importance of optimal nutrition management is fundamental for this to improve. Results from this service evaluation can be used to improve practice in this unit. A further study with a greater number of cases incorporating views from the wider range of MDT members would be beneficial to determine the validity of these findings.

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