Using Nurse-Driven Protocols to Eliminate Routine Gastric Residual Volume Measurements: A Retrospective Study

Abstract

Background Multiple critical care guidelines support the elimination of routine gastric residual volume monitoring in patients receiving enteral nutrition. However, transitioning nursing practice away from routine gastric residual volume assessments has proved challenging. Objective To evaluate outcomes after the elimination of routine gastric residual volume monitoring in a 14-bed adult intensive care unit at a large teaching hospital in the southeastern United States. Methods Practice change was accomplished through in-service training and implementation of a validated protocol. Data were collected for 30 days before and 30 days after protocol implementation to determine effects on the total volume of enteral nutrition received as well as the rate of adverse events after elimination of routine gastric residual volume assessments (n = 22) as compared with previous standard practice (n = 25). Results When gastric residual volume was not measured, the mean (SD) percentage of enteral nutrition delivery was 81% (12%) of the ordered volume, compared with 60% (18%) in the historic control group (P = .002). Eliminating gastric residual volume monitoring was not associated with an increased rate of adverse events (emesis, aspiration pneumonia) or a change in length of stay. Nursing staff demonstrated a high degree of compliance with this protocol change. Conclusion The findings of this study indicate that the elimination of routine gastric residual volume assessment does not increase the rate of adverse events and results in increased nutrition provision. Use of a protocol for practice change as well as mandatory in-service training may effect changes in nursing practice.