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.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.
A retrospective data analysis was performed on mechanically ventilated adult patients admitted to a single cancer centre ITU between February 2017 to December 2018. An ideal sample size of 369 patients was calculated using the Sample Size Calculation for Population Proportion Estimation. Based on the approximation that four patients per week are ventilated in this centre's ITU, this timeframe was chosen in order to generate an adequate number of records. Demographic data and reason for ITU admission was obtained from patients’ electronic records. To measure if early enteral nutrition (EN) was administered appropriately and without interruption as per guidelines, information on the following was extracted from data: -Route and type of nutrition given -Time taken to initiate feed post admission -Reasons why EN was not initiated or was delayed -Number of occasions and length of time EN, if started, was disrupted. Records were analysed to find clinical reasons why EN may have been delayed or omitted as listed in the exclusion criteria. Due to time constraints the first 211 records were analyzed and from these 64 cases were included. One focus group took place due to limited resources. Five participants from the same team within the unit were involved. There were three band 6's and two band 5's, providing an equal spread of experience within the group. The focus group took place in a private room. Stimulus open, non-leading questions were used as a tool to guide the discussion. Notes were made during the focus group by an observer to capture body language and other behavioural factors. The discussion was recorded using the Hospital Trust's Dictaphone and transcribed verbatim independently. This was stored in a password protected file.
