Abstract
Purpose: The purpose of this quality improvement project was to develop and evaluate a feeding tolerance tool used in preterm neonates to eliminate the practice of routine gastric residual aspiration, prior to gavage feedings, and rely predominantly on physiologic findings to determine feeding tolerance.|Significance: Routine gastric residual aspiration has been shown to be an unreliable predictor of feeding tolerance. Discontinuing routine residual aspiration has been shown to decrease the time to full enteral feedings, due to the elimination of feeding cessation that is a direct result of increased residuals even when physical findings of feeding intolerance were not present.|Sample/Settings An evidence-based feeding tolerance tool was developed and implemented at a 27-bed level III neonatal intensive care unit (NICU) in Carmichael, California. Neonates admitted to the NICU, at less than or equal to 34 0/7 weeks gestation, and who required gavage tube feedings, were included in this quality improvement project.|Methods: Education of the nursing staff was completed and included information about the evidence-based practice change as well as education on the feeding assessment tool. A retrospective chart review was completed on 30 neonates pre-intervention and 30 neonates post-intervention implementation and included time to full feedings, length of stay, emesis, and incidence of NEC.|Results: Pre-implementation data revealed a mean time to full feedings of 9.5 days compared to a mean of 9.9 days post intervention. The length of stay in the NICU was also compared which revealed a mean of 56.5 days pre-intervention and 55.3 days post-implementation of the feeding assessment tool. While emesis rates increased for overall for the post intervention group, neither pre or post had any cases of NEC.|Conclusion: A standardized protocol for assessment of feeding tolerance and advancement of enteral feeds can potentially decrease length of time to full feedings and decrease the length of stay in the NICU.