Barriers to Delivery of Enteral Nutrition in PICU English

Introduction

A barrier is something that hinders your ability to deliver adequate amounts of enteral nutrition. Below is a list of 25 items that have been identified as barriers to feeding critically ill patients.

Read each one carefully. Consider if you think the item is a barrier in your PICU, and indicate the DEGREE to which it hinders the provision of enteral nutrition in your PICU on a scale of 0-7 where 0 means ‘not at all’ (you believe that it is not a barrier) and number 7 means ‘an extreme amount’ (you believe that the provision of EN is severely affected by this factor). For each potential barrier, indicate the number that best reflects on average the situation in your ICU.

Question Title

Delivery of Enteral Nutrition to the Patient

	Not at all	Very little	A little	A moderate amount	A lot	A great deal	An extreme amount
1. Delay in physicians ordering the initiation of EN.	1. Delay in physicians ordering the initiation of EN. Not at all	1. Delay in physicians ordering the initiation of EN. Very little	1. Delay in physicians ordering the initiation of EN. A little	1. Delay in physicians ordering the initiation of EN. A moderate amount	1. Delay in physicians ordering the initiation of EN. A lot	1. Delay in physicians ordering the initiation of EN. A great deal	1. Delay in physicians ordering the initiation of EN. An extreme amount
2. Waiting for physician to order and check x-ray to confirm tube placement.	2. Waiting for physician to order and check x-ray to confirm tube placement. Not at all	2. Waiting for physician to order and check x-ray to confirm tube placement. Very little	2. Waiting for physician to order and check x-ray to confirm tube placement. A little	2. Waiting for physician to order and check x-ray to confirm tube placement. A moderate amount	2. Waiting for physician to order and check x-ray to confirm tube placement. A lot	2. Waiting for physician to order and check x-ray to confirm tube placement. A great deal	2. Waiting for physician to order and check x-ray to confirm tube placement. An extreme amount
3. Frequent displacement of feeding tube, requiring reinsertion.	3. Frequent displacement of feeding tube, requiring reinsertion. Not at all	3. Frequent displacement of feeding tube, requiring reinsertion. Very little	3. Frequent displacement of feeding tube, requiring reinsertion. A little	3. Frequent displacement of feeding tube, requiring reinsertion. A moderate amount	3. Frequent displacement of feeding tube, requiring reinsertion. A lot	3. Frequent displacement of feeding tube, requiring reinsertion. A great deal	3. Frequent displacement of feeding tube, requiring reinsertion. An extreme amount
4. Delays in initiating motility agents in patients not tolerating enteral nutrition (i.e. high gastric residual volumes).	4. Delays in initiating motility agents in patients not tolerating enteral nutrition (i.e. high gastric residual volumes). Not at all	4. Delays in initiating motility agents in patients not tolerating enteral nutrition (i.e. high gastric residual volumes). Very little	4. Delays in initiating motility agents in patients not tolerating enteral nutrition (i.e. high gastric residual volumes). A little	4. Delays in initiating motility agents in patients not tolerating enteral nutrition (i.e. high gastric residual volumes). A moderate amount	4. Delays in initiating motility agents in patients not tolerating enteral nutrition (i.e. high gastric residual volumes). A lot	4. Delays in initiating motility agents in patients not tolerating enteral nutrition (i.e. high gastric residual volumes). A great deal	4. Delays in initiating motility agents in patients not tolerating enteral nutrition (i.e. high gastric residual volumes). An extreme amount
5. Delays and difficulties in obtaining small bowel access in patients not tolerating enteral nutrition (i.e. high gastric residual volumes).	5. Delays and difficulties in obtaining small bowel access in patients not tolerating enteral nutrition (i.e. high gastric residual volumes). Not at all	5. Delays and difficulties in obtaining small bowel access in patients not tolerating enteral nutrition (i.e. high gastric residual volumes). Very little	5. Delays and difficulties in obtaining small bowel access in patients not tolerating enteral nutrition (i.e. high gastric residual volumes). A little	5. Delays and difficulties in obtaining small bowel access in patients not tolerating enteral nutrition (i.e. high gastric residual volumes). A moderate amount	5. Delays and difficulties in obtaining small bowel access in patients not tolerating enteral nutrition (i.e. high gastric residual volumes). A lot	5. Delays and difficulties in obtaining small bowel access in patients not tolerating enteral nutrition (i.e. high gastric residual volumes). A great deal	5. Delays and difficulties in obtaining small bowel access in patients not tolerating enteral nutrition (i.e. high gastric residual volumes). An extreme amount
6. In resuscitated, hemodynamically stable patients, other aspects of patient care still take priority over nutrition.	6. In resuscitated, hemodynamically stable patients, other aspects of patient care still take priority over nutrition. Not at all	6. In resuscitated, hemodynamically stable patients, other aspects of patient care still take priority over nutrition. Very little	6. In resuscitated, hemodynamically stable patients, other aspects of patient care still take priority over nutrition. A little	6. In resuscitated, hemodynamically stable patients, other aspects of patient care still take priority over nutrition. A moderate amount	6. In resuscitated, hemodynamically stable patients, other aspects of patient care still take priority over nutrition. A lot	6. In resuscitated, hemodynamically stable patients, other aspects of patient care still take priority over nutrition. A great deal	6. In resuscitated, hemodynamically stable patients, other aspects of patient care still take priority over nutrition. An extreme amount
7. Nutrition therapy not routinely discussed on ward rounds.	7. Nutrition therapy not routinely discussed on ward rounds. Not at all	7. Nutrition therapy not routinely discussed on ward rounds. Very little	7. Nutrition therapy not routinely discussed on ward rounds. A little	7. Nutrition therapy not routinely discussed on ward rounds. A moderate amount	7. Nutrition therapy not routinely discussed on ward rounds. A lot	7. Nutrition therapy not routinely discussed on ward rounds. A great deal	7. Nutrition therapy not routinely discussed on ward rounds. An extreme amount
8. Severe fluid restriction (especially post-operative cardiac surgery).	8. Severe fluid restriction (especially post-operative cardiac surgery). Not at all	8. Severe fluid restriction (especially post-operative cardiac surgery). Very little	8. Severe fluid restriction (especially post-operative cardiac surgery). A little	8. Severe fluid restriction (especially post-operative cardiac surgery). A moderate amount	8. Severe fluid restriction (especially post-operative cardiac surgery). A lot	8. Severe fluid restriction (especially post-operative cardiac surgery). A great deal	8. Severe fluid restriction (especially post-operative cardiac surgery). An extreme amount
9. Conservative PICU feeding protocol.	9. Conservative PICU feeding protocol. Not at all	9. Conservative PICU feeding protocol. Very little	9. Conservative PICU feeding protocol. A little	9. Conservative PICU feeding protocol. A moderate amount	9. Conservative PICU feeding protocol. A lot	9. Conservative PICU feeding protocol. A great deal	9. Conservative PICU feeding protocol. An extreme amount
10. Difficulty in delivering enteral feed due to feeding tube obstruction or pump delivery problems with thickened formula.	10. Difficulty in delivering enteral feed due to feeding tube obstruction or pump delivery problems with thickened formula. Not at all	10. Difficulty in delivering enteral feed due to feeding tube obstruction or pump delivery problems with thickened formula. Very little	10. Difficulty in delivering enteral feed due to feeding tube obstruction or pump delivery problems with thickened formula. A little	10. Difficulty in delivering enteral feed due to feeding tube obstruction or pump delivery problems with thickened formula. A moderate amount	10. Difficulty in delivering enteral feed due to feeding tube obstruction or pump delivery problems with thickened formula. A lot	10. Difficulty in delivering enteral feed due to feeding tube obstruction or pump delivery problems with thickened formula. A great deal	10. Difficulty in delivering enteral feed due to feeding tube obstruction or pump delivery problems with thickened formula. An extreme amount

Question Title

Dietician Support

Please do not answer the next 4 questions if you do not have a dietician

	Not at all	Very little	A little	A moderate amount	A lot	A great deal	An extreme amount
11. Waiting for the dietician to assess the patient.	11. Waiting for the dietician to assess the patient. Not at all	11. Waiting for the dietician to assess the patient. Very little	11. Waiting for the dietician to assess the patient. A little	11. Waiting for the dietician to assess the patient. A moderate amount	11. Waiting for the dietician to assess the patient. A lot	11. Waiting for the dietician to assess the patient. A great deal	11. Waiting for the dietician to assess the patient. An extreme amount
12. Dietician not routinely present on weekday patient rounds.	12. Dietician not routinely present on weekday patient rounds. Not at all	12. Dietician not routinely present on weekday patient rounds. Very little	12. Dietician not routinely present on weekday patient rounds. A little	12. Dietician not routinely present on weekday patient rounds. A moderate amount	12. Dietician not routinely present on weekday patient rounds. A lot	12. Dietician not routinely present on weekday patient rounds. A great deal	12. Dietician not routinely present on weekday patient rounds. An extreme amount
13. No or not enough dietician coverage during evenings, weekends and holidays.	13. No or not enough dietician coverage during evenings, weekends and holidays. Not at all	13. No or not enough dietician coverage during evenings, weekends and holidays. Very little	13. No or not enough dietician coverage during evenings, weekends and holidays. A little	13. No or not enough dietician coverage during evenings, weekends and holidays. A moderate amount	13. No or not enough dietician coverage during evenings, weekends and holidays. A lot	13. No or not enough dietician coverage during evenings, weekends and holidays. A great deal	13. No or not enough dietician coverage during evenings, weekends and holidays. An extreme amount
14. Not enough time dedicated to education and training on how to optimally feed patients.	14. Not enough time dedicated to education and training on how to optimally feed patients. Not at all	14. Not enough time dedicated to education and training on how to optimally feed patients. Very little	14. Not enough time dedicated to education and training on how to optimally feed patients. A little	14. Not enough time dedicated to education and training on how to optimally feed patients. A moderate amount	14. Not enough time dedicated to education and training on how to optimally feed patients. A lot	14. Not enough time dedicated to education and training on how to optimally feed patients. A great deal	14. Not enough time dedicated to education and training on how to optimally feed patients. An extreme amount

Question Title

PICU Resources

	Not at all	Very little	A little	A moderate amount	A lot	A great deal	An extreme amount
15. Delays to preparing or obtaining non-standard enteral feeds.	15. Delays to preparing or obtaining non-standard enteral feeds. Not at all	15. Delays to preparing or obtaining non-standard enteral feeds. Very little	15. Delays to preparing or obtaining non-standard enteral feeds. A little	15. Delays to preparing or obtaining non-standard enteral feeds. A moderate amount	15. Delays to preparing or obtaining non-standard enteral feeds. A lot	15. Delays to preparing or obtaining non-standard enteral feeds. A great deal	15. Delays to preparing or obtaining non-standard enteral feeds. An extreme amount
16. No or not enough feeding pumps on the unit.	16. No or not enough feeding pumps on the unit. Not at all	16. No or not enough feeding pumps on the unit. Very little	16. No or not enough feeding pumps on the unit. A little	16. No or not enough feeding pumps on the unit. A moderate amount	16. No or not enough feeding pumps on the unit. A lot	16. No or not enough feeding pumps on the unit. A great deal	16. No or not enough feeding pumps on the unit. An extreme amount

Question Title

Healthcare Professional Attitudes and Behaviour

	Not at all	Very little	A little	A moderate amount	A lot	A great deal	An extreme amount
17. Non-PICU physicians (i.e. surgeons, gastroenterologists) requesting patients not be fed enterally.	17. Non-PICU physicians (i.e. surgeons, gastroenterologists) requesting patients not be fed enterally. Not at all	17. Non-PICU physicians (i.e. surgeons, gastroenterologists) requesting patients not be fed enterally. Very little	17. Non-PICU physicians (i.e. surgeons, gastroenterologists) requesting patients not be fed enterally. A little	17. Non-PICU physicians (i.e. surgeons, gastroenterologists) requesting patients not be fed enterally. A moderate amount	17. Non-PICU physicians (i.e. surgeons, gastroenterologists) requesting patients not be fed enterally. A lot	17. Non-PICU physicians (i.e. surgeons, gastroenterologists) requesting patients not be fed enterally. A great deal	17. Non-PICU physicians (i.e. surgeons, gastroenterologists) requesting patients not be fed enterally. An extreme amount
18. Nurses failing to progress feeds as per the feeding protocol.	18. Nurses failing to progress feeds as per the feeding protocol. Not at all	18. Nurses failing to progress feeds as per the feeding protocol. Very little	18. Nurses failing to progress feeds as per the feeding protocol. A little	18. Nurses failing to progress feeds as per the feeding protocol. A moderate amount	18. Nurses failing to progress feeds as per the feeding protocol. A lot	18. Nurses failing to progress feeds as per the feeding protocol. A great deal	18. Nurses failing to progress feeds as per the feeding protocol. An extreme amount
19. Enteral feeds withheld due to diarrhoea.	19. Enteral feeds withheld due to diarrhoea. Not at all	19. Enteral feeds withheld due to diarrhoea. Very little	19. Enteral feeds withheld due to diarrhoea. A little	19. Enteral feeds withheld due to diarrhoea. A moderate amount	19. Enteral feeds withheld due to diarrhoea. A lot	19. Enteral feeds withheld due to diarrhoea. A great deal	19. Enteral feeds withheld due to diarrhoea. An extreme amount
20. Fear of adverse events due to aggressively enterally feeding patients.	20. Fear of adverse events due to aggressively enterally feeding patients. Not at all	20. Fear of adverse events due to aggressively enterally feeding patients. Very little	20. Fear of adverse events due to aggressively enterally feeding patients. A little	20. Fear of adverse events due to aggressively enterally feeding patients. A moderate amount	20. Fear of adverse events due to aggressively enterally feeding patients. A lot	20. Fear of adverse events due to aggressively enterally feeding patients. A great deal	20. Fear of adverse events due to aggressively enterally feeding patients. An extreme amount
21. Enteral feeds withheld for bedside procedures, such as physiotherapy, turns, and administration of certain medications.	21. Enteral feeds withheld for bedside procedures, such as physiotherapy, turns, and administration of certain medications. Not at all	21. Enteral feeds withheld for bedside procedures, such as physiotherapy, turns, and administration of certain medications. Very little	21. Enteral feeds withheld for bedside procedures, such as physiotherapy, turns, and administration of certain medications. A little	21. Enteral feeds withheld for bedside procedures, such as physiotherapy, turns, and administration of certain medications. A moderate amount	21. Enteral feeds withheld for bedside procedures, such as physiotherapy, turns, and administration of certain medications. A lot	21. Enteral feeds withheld for bedside procedures, such as physiotherapy, turns, and administration of certain medications. A great deal	21. Enteral feeds withheld for bedside procedures, such as physiotherapy, turns, and administration of certain medications. An extreme amount
22. Enteral feeds being withheld in advance of procedures or operating department visits.	22. Enteral feeds being withheld in advance of procedures or operating department visits. Not at all	22. Enteral feeds being withheld in advance of procedures or operating department visits. Very little	22. Enteral feeds being withheld in advance of procedures or operating department visits. A little	22. Enteral feeds being withheld in advance of procedures or operating department visits. A moderate amount	22. Enteral feeds being withheld in advance of procedures or operating department visits. A lot	22. Enteral feeds being withheld in advance of procedures or operating department visits. A great deal	22. Enteral feeds being withheld in advance of procedures or operating department visits. An extreme amount
23. Lack of familiarity with current guidelines for nutrition in the PICU.	23. Lack of familiarity with current guidelines for nutrition in the PICU. Not at all	23. Lack of familiarity with current guidelines for nutrition in the PICU. Very little	23. Lack of familiarity with current guidelines for nutrition in the PICU. A little	23. Lack of familiarity with current guidelines for nutrition in the PICU. A moderate amount	23. Lack of familiarity with current guidelines for nutrition in the PICU. A lot	23. Lack of familiarity with current guidelines for nutrition in the PICU. A great deal	23. Lack of familiarity with current guidelines for nutrition in the PICU. An extreme amount
24. General belief among PICU team that provision of adequate nutrition does not affect patient outcomes.	24. General belief among PICU team that provision of adequate nutrition does not affect patient outcomes. Not at all	24. General belief among PICU team that provision of adequate nutrition does not affect patient outcomes. Very little	24. General belief among PICU team that provision of adequate nutrition does not affect patient outcomes. A little	24. General belief among PICU team that provision of adequate nutrition does not affect patient outcomes. A moderate amount	24. General belief among PICU team that provision of adequate nutrition does not affect patient outcomes. A lot	24. General belief among PICU team that provision of adequate nutrition does not affect patient outcomes. A great deal	24. General belief among PICU team that provision of adequate nutrition does not affect patient outcomes. An extreme amount
25. Lack of staff knowledge and support around breastfeeding mothers.	25. Lack of staff knowledge and support around breastfeeding mothers. Not at all	25. Lack of staff knowledge and support around breastfeeding mothers. Very little	25. Lack of staff knowledge and support around breastfeeding mothers. A little	25. Lack of staff knowledge and support around breastfeeding mothers. A moderate amount	25. Lack of staff knowledge and support around breastfeeding mothers. A lot	25. Lack of staff knowledge and support around breastfeeding mothers. A great deal	25. Lack of staff knowledge and support around breastfeeding mothers. An extreme amount

Question Title

Personal Characteristics of the healthcare professional completing this survey

What is your primary clinical specialty?

Medical doctor

Nurse

Dietitian

Question Title

How long have you been working in PICU?

0-5 years

6-10 years

11-15 years

greater than 15 years

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What country is your PICU in?

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What type of PICU do you work in?

General PICU

Mixed cardiac and general PICU

Cardiac PICU

Mixed PICU-NICU

Other (please specify)

Question Title

Delivery of Enteral Nutrition to the Patient

Question Title

Dietician SupportPlease do not answer the next 4 questions if you do not have a dietician

Question Title

PICU Resources

Question Title

Healthcare Professional Attitudes and Behaviour

Question Title

Personal Characteristics of the healthcare professional completing this surveyWhat is your primary clinical specialty?

Question Title

How long have you been working in PICU?

Question Title

What country is your PICU in?

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What type of PICU do you work in?

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Are there any other things you consider barriers that are not on this list?

Dietician Support

Please do not answer the next 4 questions if you do not have a dietician

Personal Characteristics of the healthcare professional completing this survey

What is your primary clinical specialty?