Construction Of Risk Management Scheme For Enteral Feeding Intolerance In ICU Patients

ObjectivesThe objective of this study was to establish a risk management scheme for enteral feeding intolerance in ICU patients by means of current situation investigation,evidence-based nursing and expert consultation.Methods(1)A prospective observational study method was adopted,combined with enteral nutrition feeding intolerance risk assessment tool for ICU patients,and severe patients with feeding intolerance risk were screened in the comprehensive ICU of a Grade-III hospital in Shanghai from January to March 2022.The occurrence of feeding intolerance was observed and recorded.To provide the basis for the establishment of risk management program of enteral feeding intolerance for this population.(2)Based on the evidence-based medicine model,through systematic search of related websites and databases on the risk management of enteral feeding intolerance of ICU patients,the initial plan of enteral feeding intolerance risk management of ICU patients.(3)Two rounds of expert consultation were carried out,and the preliminary program contents were adjusted and supplemented according to the expert opinions,and finally an evidence-based management program for patients with the risk of intestinal feeding intolerance in ICU was constructed.Results(1)The incidence of feeding intolerance was 82.6%in severe patients at risk of feeding intolerance.Among the manifestations of gastrointestinal intolerances,constipation had the highest incidence of 52.2%.(2)A total of 14 articles were included,including 3 guidelines,5 expert consensus,2 evidence summaries,and 4 systematic reviews,and 24 pieces of evidence were summarized from 4 aspects,including assessment,feeding plan formulation,tolerance monitoring,and complication management.On the basis of the best evidence and clinical practice,a management plan was initially formed,including 4 first-level items,14 second-level items and 39 third-level items.(3)On this basis,15 experts were selected for expert consultation.The questionnaire recovery rates of the two rounds of expert consultation were 83%and 100%,respectively.The expert authority coefficient was 0.85 and 0.86.The Kendall coordination coefficients of items at all levels were 0.357,0.148 and 0.206(P<0.05).The final management plan included 4 first-level items,15 second-level items and 38 third-level items,including assessment and screening,team building,feeding plan formulation,tolerance monitoring and treatment.ConclusionsThe risk management plan of enteral nutrition feeding intolerance for ICU patients constructed based on evidence-based nursing and Delphi consultation method in this study is scientific,reliable and comprehensive,which can provide reference value for clinical nursing work,thereby providing part of reference for reducing the occurrence of enteral nutrition feeding intolerance and improving the effect of nutritional support treatment.