Auditing of enteral nutrition nursing care in critical care patients

  • Tahereh Al-Jalil Student Research Committee, School of Nursing and Midwifery, North Khorasan University of Medical Sciences, Bojnurd, Iran
  • Golbahar Gray Student Research Committee, School of Nursing and Midwifery, North Khorasan University of Medical Sciences, Bojnurd, Iran
  • Maryam Rasouli Department of Pediatric Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  • Tooba Hoseini Azizi Department of Nursing, School of Nursing and Midwifery, North Khorasan University of Medical Sciences, Bojnurd, Iran
  • Sima Sadat Hejazi* Department of Nursing, School of Nursing and Midwifery, North Khorasan University of Medical Sciences, Bojnurd, Iran
Keywords: enteral nutrition, nursing audit, critical care


Background and Aim: Enteral nutrition standards noncompliance is one of the factors that threatens patient safety.  Auditing is an important part in quality improvement processes. The aim of this study was to determine enteral nutrition nursing care conformity rate with standards in the critical care units.

Methods and Materials: In this descriptive study, 400 enteral feeding nursing care were assessed via time and event sampling methods. The tool was a researcher made check list in three fields: pre-feeding, feeding, and post feeding nursing care. Content validity and inter-rater coefficient reliability were calculated for checklist. The obtained data were analyzed using descriptive statistics.

Results: The most conformity rate with standards was in feeding (86%), pre-feeding (3/8 %) and post feeding (2/3%) field, respectively. Determination of PH (100%) and accurate gastric residual volume (99.8%) in pre-feeding field, disconnection of the syringe from catheter after feeding, in feeding filed and accurate documentation of the care (99.3%) in post feeding field, were not implemented in the most of cases.

Conclusion: Enteral nutrition nursing care is far from standards in the pre and post feeding fields. Lack of the clear clinical guidelines, shortage of nursing staff and equipment and inadequate training are relating factors.


Potter P, Perry G, Stockert P, Hall A. Fundamentals of Nursing. 8 ed. Philadelphia: mosby; 2016, 996.

Mosazadeh S, Khaleghdoost Mohammadi T, Hasavari F, Kazem Nejad Leili E. Study the chance of respiratory aspiration in intermittent bolus tube feeding in‎ ICU and Trauma ward patients. Journal of Holistic Nursing And Midwifery. 2011;21(2):40-6. (persian)

Abbasi Nazari M, Fariborz Farsad B, Mostafa Alavi S, Bakhshandeh H, Kharazmkia A, Ariaeinejad P. Comparison of Maastricht index between ICU admitted patients receiving a standard enteral feeding product or kitchen made enteral feeding in a teaching hospital of Iran. Journal of Mazandaran University of Medical Sciences. 2011;21(81):54-60. (persian)

Kattelmann KK, Hise M, Russell M, Charney P, Stokes M, Compher C. Preliminary evidence for a medical nutrition therapy protocol: enteral feedings for critically ill patients. J Am Diet Assoc. 2006;106(8):1226-41.

Williams TA, Leslie GD. A review of the nursing care of enteral feeding tubes in critically ill adults: part I. Intensive Crit Care Nurs. 2004;20(6):330-43.

Dehghani K, Nasiriani K, Mousavi T. Investigating intensive care unit nurses' performance and its adjusting with standard. Journal of Shahid Sadoughi University of Medical Sciences. 2014;21 (6):808-15. (persian)

Gupta B, Agrawal P, Soni KD, Yadav V, Dhakal R, Khurana S, et al. Enteral nutrition practices in the intensive care unit: Understanding of nursing practices and perspectives. J Anaesthesiol Clin Pharmacol. 2012;28(1):41-4.

Xu Y, Ren X, Shi W, Jiang H. Implementation of the best practice in nasogastric tube feeding of critically ill patients in a neurosurgical intensive care unit. Int J Evid Based Healthc. 2013;11(2):128-33.

Yousefzadeh S, Shabbidar S, Dehnadi Moghaddam A, Ahmadi Dafchahi M. Assessment of nutritional support in head trauma patients in Neurosurgery Intensive Care Unit. Journal of Gorgan University of Medical Sciences. 2007;9(3):53-8. (persian)

Razmara R, Masoumpoor A, Dabirian A, Pahlavanzadeh B. Auditing of pre & postoperative nursing cares in neonates admitted at selected hospitals of shahid beheshti university of medical sciences. Journal of Urmia Nursing And Midwifery Faculty. 2015;13(8):718-27. (persian)

Najafi Anari H, Rassouli M, Atashzadeh Shourideh F, Namdari M. Auditing preterm neonatal nutrition nursing care. Quarterly Journal of Nursing Management. 2014; 2(4) 29-37. (persian)

Najafi Pur S, Rassouli M, Masoum Pur A, Kavousi A. Auditing of preventive nursing care regarding neonatal hypothermia at Shahid Beheshti Medical Sciences University selected hospitals in 2011. Modern Care Journal. 2012;9(2):104-13. (persian)

Lynn P. Taylor's Clinical Nursing Skills: A Nursing Process Approach. 4 ed. Philadelphia Lippincott Williams & Wilkins; 2014; 578-587.

Marshall AP, Cahill NE, Gramlich L, MacDonald G, Alberda C, Heyland DK. Optimizing nutrition in intensive care units: empowering critical care nurses to be effective agents of change. Am J Crit Care. 2012;21(3):186-94.

Ashouri E, Fatehi N. A comparison of performing tube feeding with the standard procedures at selected educational and treatment centers of Isfahan University of Medical Sciences, Iran. Iran J Nurs Midwifery Res. 2012;17(2 Suppl 1):S80-4.

Shayesteh F, Poudineh S, Mohammad Zadeh M, Pouryazdanpanah M, Ayoudi S, Norouzy A. Assessment of nutritional intake in intensive care unit patients of Ghaem hospital. Medical Journal of Mashhad University of Medical Sciences. 2015;58(4):217-24. (persian)

Cahill NE, Murch L, Cook D, Heyland DK. Barriers to feeding critically ill patients: a multicenter survey of critical care nurses. J Crit Care. 2012;27(6):727-34.

Ros C, McNeill L, Bennett P. Review: nurses can improve patient nutrition in intensive care. J Clin Nurs. 2009;18(17):2406-15.

Marshall AP, West SH. Enteral feeding in the critically ill: are nursing practices contributing to hypocaloric feeding? Intensive Crit Care Nurs. 2006;22(2):95-105.

Yip KF, Rai V, Wong KK. Evaluation of delivery of enteral nutrition in mechanically ventilated Malaysian ICU patients. BMC Anesthesiol. 2014;14:127.

Reid C. Frequency of under- and overfeeding in mechanically ventilated ICU patients: causes and possible consequences. J Hum Nutr Diet. 2006;19(1):13-22.

O'Meara D, Mireles-Cabodevila E, Frame F, Hummell AC, Hammel J, Dweik RA, et al. Evaluation of delivery of enteral nutrition in critically ill patients receiving mechanical ventilation. Am J Crit Care. 2008;17(1):53-61.

Marshall A, West S. Nutritional intake in the critically ill: improving practice through research. Aust Crit Care. 2004;17(1):6-8, 10-5.

Elke G, Felbinger TW, Heyland DK. Gastric residual volume in critically ill patients: a dead marker or still alive? Nutr Clin Pract. 2015;30(1):59-71.

Hanifi N, Mohamadi E. Survey of causes of faculty nursing documentation. Journal of hayat. 2004;10(2):39-46. (persian)

Nazari R, Haji Ahmadi M, Dadashzade M, Asgari P. Study of hand hygiene behavior among nurses in Critical Care Units. Journal of Critical Care Nursing. 2011;4(2):93-6. (persian)

Salimi M, Masoumpoor A, Shirinabadi Farahani A, Shakeri N, Alaee Karharoudy F, Shiri H. Auditing nursing care related to weaning neonates from mechanical ventilation in neonatal intensive care units. Journal of hayat. 2016;22(2):159-74. (persian)

Tabrizi js, Partovi y. Clinical Audit of Hand Hygiene Process of Nurses in a General Hospital in Tabriz city. Journal of Hospital. 2015;1 4(2)23-34. (Persian)

How to Cite
Al-Jalil T, Gray G, Rasouli M, Hoseini Azizi T, Hejazi* S. Auditing of enteral nutrition nursing care in critical care patients. NPT. 6(1):18-25.
Original Article(s)