부산대학교 도서관

Background: As a result of the complex nature of neurosurgical patients, nasogastric (NG) tube feeding is often implemented for patients who are unable to consume adequate oral intake. During recovery, patients on enteral nutrition (EN) are progressed to oral nutrition, which can result in NGT removal and discontinuation of supportive feeding plans. This is often before patients become established on sufficient oral intake to meet their nutritional requirements. Methods: We conducted an exploration of current NG removal practices in patients (n = 23) across five neurosurgical wards over a 3‐month period to assess practitioner review response times, NG feeding duration, decision making on NG removal, and the influence of dietary recommendations and differing EN protocols on patients' ability to meet their nutritional requirements. Our aim was to use this data to design and implement a protocol to improve consistency of these practices. Results: After oral intake was commenced, only those receiving supplementary EN achieved nutritional targets immediately. Conversely, no patient who had their NGT removed at this stage achieved these targets. Following NG removal, the likelihood of a patient meeting nutritional targets was influenced by the decision maker, supporting the practice of registered dietitian led cessation of NG feeding. These findings led us to develop an "NG Transition Feeding Protocol" to serve as a simple, clear pathway which treating teams can utilise to guide NG feeding decisions. Conclusions: NG feeding supports neurosurgical patients to meet nutritional requirements in the early stages following commencement of oral intake. The development of an "NG Transition Feeding Protocol" may help to improve consistency of transition feeding on neurosurgical wards, allowing time for nutrition assessment to support informed decisions around NG removal. The aim of this protocol is to improve the efficiency of transition feeding, improve dietetic workload efficiency, nursing staff confidence and avoid compromising nutritional status of patients as a result of the early cessation of EN. Key points: We found that once oral nutritional intake was commenced, only those receiving supplementary supplementary nasogastric (NG) feeding were able to meet their nutritional targets in the early stages of dietary reintroduction. Conversely, no patient who had their NG tube removed immediately after the commencement of oral intake met these targets; therefore, premature NG removal risks compromising nutritional status of patients unnecessarily.We observed that following NG removal, the likelihood of a patient meeting nutritional targets was influenced by the decision maker, supporting the practice of registered dietitian‐led cessation of NG feeding.In cases where this did not occur, we found that unclear decision making on who has designated responsibility for NG removal can result in inconsistencies in practice, potentially leading to confusion between multidisciplinary team members about these roles.Our findings have helped define a clear multidisciplinary pathway between speech and language therapist, registered dietitians and nursing colleagues to optimise nutrition support for patients in this setting. The development of an "NG Transition Feeding Protocol" might help to improve consistency of transition feeding on the neurosurgical wards, allowing adequate time for formal nutrition assessment to support informed decisions around NG removal.Our hope is that this protocol will improve the efficiency of transition, which in turn may improve dietetic workload efficiency, nursing staff confidence regarding decision making and avoid compromising nutritional status of patients as a result of the early cessation of enteral feeding. [ABSTRACT FROM AUTHOR]