Nutrition support practices in the intensive care unit of a tertiary hospital in Ghana

Background: Nutrition support is recognised as an important therapy for attenuating the catabolic effects of critical illnesses, including malnutrition prevention. However, variations in nutrition support practices make it difficult to achieve optimal outcomes in the intensive care unit (ICU).

Objectives: To explore current nutrition support practices among healthcare professionals (doctors and nurses) in the ICU of a tertiary hospital in Ghana.

Methods: Via a cross-sectional survey, the nutrition support practices and self-reported skills of 30 ICU healthcare professionals (23 nurses and 7 doctors) providing nutrition support were explored. Results are presented as themes with frequencies and proportions. Categorical data were analysed using Fisher's exact test. Statistical significance was set at p<0.05.

Results: Most of the respondents were young and had limited ICU experience. Almost half of the respondents were unaware of or were not familiar with the content of an in-house feeding protocol for both enteral nutrition (EN) and parenteral nutrition support, despite a majority reporting the feeding protocol as the main source of nutrition support information. There was a general lack of standardisation of execution of most nutrition support practices, especially with the pattern of EN delivery, usual method of optimising EN, and gastric residual volume threshold used to guide practice. Most respondents self-reported being average/satisfactory in the management of nutrition support.

Conclusion: The study revealed that healthcare professionals in our ICU had varying nutrition support practices and competencies. There is a need for standardised and practical feeding protocols in accessible formats, ongoing education, and training in nutrition support to improve nutrition support practices and competencies of healthcare professionals providing nutrition support in the ICU setting.

Contribution of the study: This study is the first to describe challenges of nutrition support practices in an intensive care unit (ICU) in Ghana and is among limited data on this topic from African countries. This study has provided important insights into both the needs and opportunities for enhancing clinical nutrition skills and knowledge, and the practical application of such improved knowledge. As such, these data are important for local quality improvement for both clinical care of ICU patients and for professional development of healthcare personnel in resource-constrained hospital settings.