32% agreed or strongly agreed that they had changed their nutrition practice as a result of study participation. On average nurses were exposed to 7 study related activities or resources, and on average rated these as 4 somewhat useful. Table 4 describes Inhibitors,Modulators,Libraries the results of the evaluation questionnaire by site. A total of 182 critical care staff nurses, 25 physicians,12 dietitians and 11 other responded to the Barriers to Enterally Feeding Critically Ill Patients questionnaire at baseline, and 118 nurses, 12 physicians, 10 dietitians and 3 other at follow up. for an overall response rate of 45% and 29% at the two respective time points. Respondent characteristics were similar at baseline and follow up. Over half were experienced staff working in ICU for greater than five years, and two thirds worked full time.
Figure 2 illustrates the change in prioritized barriers score reflecting barriers Inhibitors,Modulators,Libraries targeted for improvement by the tailored action plans at each site. The prioritized barriers score Inhibitors,Modulators,Libraries decreased in all sites between baseline and follow up with a mean change of 13 points ranging from 5 at Site 1 to 26 at Site 4. We observed a 10 point reduction in overall Inhibitors,Modulators,Libraries barriers score. The barriers score decreased for all 21 items in the questionnaire and this change was statistically significant for 16 items. The greatest change was observed in subscales 4 and 5 with a change in barriers score of 12 points and 11 points. Although the barriers score decreased at all sites for most items, the magnitude of change varied. There were 140 patients accrued in the nutrition practice audit at baseline and 138 at follow up.
Patient characteristics and clinical outcomes were similar at both time points, 55% were male with a median age of 61 years, and BMI of 27Kg m2. The majority were medical patients and the median APACHE II score was 22. The median energy and protein prescribed by the dietitian was 1745 Kcals and 96 grams respectively. In 79% of patients these energy requirements were calculated Inhibitors,Modulators,Libraries using a weight based formula ranging from 20 30 Kcals per Kg. The protein prescriptions were also calculated using a weight based formula. Median lengths of mechanical ventilation and ICU stay were 5 days and 8 days respectively, and 60 day hospital mortality was 25. 5%. Figure 3a shows the change in caloric adequacy from total nutrition at each site.
While some sites did not improve, an increase of 10% was observed at two sites. Similar results were observed for protein adequacy from total all targets nutrition. Discussion In this multicenter study of a tailored intervention to improve the provision of EN to critically ill patients, we demonstrated that this multi faceted, interdisciplinary intervention is feasible with all 5 sites successfully developing and implementing their action plans.