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JPEN J Parenter Enteral Nutr. 2015 Aug;39(6):698-706. doi: 10.1177/0148607114531787. Epub 2014 Apr 18.

Implementing the PEP uP Protocol in Critical Care Units in Canada: Results of a Multicenter, Quality Improvement Study.

Author information

1
Clinical Evaluation Research Unit, Kingston General Hospital, Kingston, Ontario, Canada Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada Department of Medicine, Queen's University, Kingston, Ontario, Canada dkh2@queensu.ca.
2
Clinical Evaluation Research Unit, Kingston General Hospital, Kingston, Ontario, Canada.
3
Clinical Evaluation Research Unit, Kingston General Hospital, Kingston, Ontario, Canada Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada.

Abstract

BACKGROUND:

Previous studies have documented widespread iatrogenic underfeeding in intensive care unit (ICU) patients. In an experimental setting, we demonstrated the safety and efficacy of a novel enteral feeding protocol designed to overcome the main barriers to adequate delivery of enteral nutrition (EN), the Enhanced Protein-Energy Provision via the Enteral Route Feeding Protocol (PEP uP protocol). The purpose of this article is to describe our experience with implementing this feeding protocol under "real-world" settings in Canada.

MATERIALS AND METHODS:

This study is a multicenter quality improvement initiative with a concurrent control group. Selected ICUs implemented the PEP uP protocol, and nutrition practices and outcomes were compared with a concurrent control group of ICUs.

RESULTS:

In 2013, of the 24 ICUs from Canada that participated in the International Nutrition Survey, 8 implemented the PEP uP protocol and the remaining 16 served as concurrent control sites. Patients at PEP uP sites received 60.1% of their prescribed energy requirements from EN compared with 49.9% in patients from control hospitals (P = .02). In addition, patients in PEP uP protocol sites received more protein from EN (61.0% vs 49.7% of prescribed amounts; P = .01), were more likely to receive protein supplements (71.8% vs 47.7%; P = .01), and were more likely to receive >80% of their protein requirements by day 3 (46.1% vs 29.3%; P = .05) compared with patients in control hospitals.

CONCLUSIONS:

In the real-life setting, the PEP uP protocol can improve the delivery of EN to critically ill patients.

KEYWORDS:

caloric intake; critical care; energy balance; feeding protocols; nutrition status; nutrition therapy; quality improvement; underfeeding

PMID:
24748597
DOI:
10.1177/0148607114531787
[Indexed for MEDLINE]

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