Dietitian-Led Feeding Tube Placement: Reducing Nursing Workload and Enhancing Patient Safety in the Intensive Care Unit.

BACKGROUND

As a result of the COVID-19 pandemic, health care systems nationally are adopting innovative strategies to streamline nursing care while optimizing outcomes. Concurrently, registered dietitian nutritionists are seeking opportunities to maximize their professional contribution and underscore their value as part of the interprofessional health care team. Implementing a feeding tube placement program led by registered dietitian nutritionists, rather than nurses, might enhance patient safety and enable dietitians to practice at an expert level while affording nurses more time for other patient care responsibilities.

LOCAL PROBLEM: In a 5-hospital health system, the COVID-19 pandemic worsened nursing shortages and increased nurse workloads and burnout. High volumes of patients with respiratory compromise increased the demand for postpyloric feeding tube placement. Challenges included unreliable placement methods and the need for bedside procedures due to transport restrictions. This situation prompted the creation of a registered dietitian nutritionist-led program for bedside feeding tube placement.

METHODS

An electromagnetic sensor-guided feeding tube placement program was implemented in phases across the health system after a successful pilot. This process included development of a feeding tube placement practice guideline, electronic health record updates, superuser training, competency development, and system-wide education.

RESULTS

One year after implementation, the program has saved more than 350 nursing hours. The number of radiographs has been reduced by 20% and the incidence of ventilator-associated pneumonia has been reduced by 67%, with no lung placements.

CONCLUSION

Enabling registered dietitian nutritionists to lead feeding tube placement is an effective strategy for optimizing patient care and safety while reducing nursing workload.