Early oral feeding after colorectal surgery: A mixed methods study of knowledge translation

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Author(s)
Robertson, Tayla R
Eldridge, Naomi E
Rattray, Megan E
Roberts, Shelley
Desbrow, Ben
Marshall, Andrea P
Ali, Azmat B
Hickman, Ingrid J
Year published
2018
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Show full item recordAbstract
Aim: Evidence-based guidelines recommend early oral feeding (EOF) as prescription of an unrestricted diet within
24 hours after colorectal surgery. The present study aimed to understand local postoperative feeding practices after
colorectal surgery; identify barriers to EOF implementation; select, tailor and implement stakeholder engagement
strategies to facilitate EOF uptake; and evaluate changes to practice.
Methods: A longitudinal, mixed methods study was undertaken, guided by the knowledge-to-action framework.
Phase 1 assessed the nature of the problem using postoperative diet Audits 1 and 2. In Phase 2, staff interviews ...
View more >Aim: Evidence-based guidelines recommend early oral feeding (EOF) as prescription of an unrestricted diet within 24 hours after colorectal surgery. The present study aimed to understand local postoperative feeding practices after colorectal surgery; identify barriers to EOF implementation; select, tailor and implement stakeholder engagement strategies to facilitate EOF uptake; and evaluate changes to practice. Methods: A longitudinal, mixed methods study was undertaken, guided by the knowledge-to-action framework. Phase 1 assessed the nature of the problem using postoperative diet Audits 1 and 2. In Phase 2, staff interviews identified barriers to EOF implementation. Results from Phases 1 and 2 were fed back to inform Phase 3 strategies. Knowledge uptake was monitored in Audits 3 and 4. Phase 4 evaluated outcomes from Audit 5. Results: In Phase 1, median time to commencement of full diet was postoperative Days 4 and 3 in Audits 1 and 2, respectively. Phase 2 identified EOF barriers, including disparities in diet upgrade practices and variable understanding of hospital diets. In Phase 3, planned strategies were implemented to improve EOF (i) educational session describing local hospital diets; (ii) consultant decision to prescribe a full diet on operation notes; and (iii) educational sessions with nursing staff describing changes to EOF practice. In Phase 4, median time to commencement of full diet improved to postoperative Day 0. Patients prescribed a full diet on operation notes increased from 0% to 82%. Conclusions: The present study successfully identified and overcame local barriers to improve EOF practices to align with guideline recommendations.
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View more >Aim: Evidence-based guidelines recommend early oral feeding (EOF) as prescription of an unrestricted diet within 24 hours after colorectal surgery. The present study aimed to understand local postoperative feeding practices after colorectal surgery; identify barriers to EOF implementation; select, tailor and implement stakeholder engagement strategies to facilitate EOF uptake; and evaluate changes to practice. Methods: A longitudinal, mixed methods study was undertaken, guided by the knowledge-to-action framework. Phase 1 assessed the nature of the problem using postoperative diet Audits 1 and 2. In Phase 2, staff interviews identified barriers to EOF implementation. Results from Phases 1 and 2 were fed back to inform Phase 3 strategies. Knowledge uptake was monitored in Audits 3 and 4. Phase 4 evaluated outcomes from Audit 5. Results: In Phase 1, median time to commencement of full diet was postoperative Days 4 and 3 in Audits 1 and 2, respectively. Phase 2 identified EOF barriers, including disparities in diet upgrade practices and variable understanding of hospital diets. In Phase 3, planned strategies were implemented to improve EOF (i) educational session describing local hospital diets; (ii) consultant decision to prescribe a full diet on operation notes; and (iii) educational sessions with nursing staff describing changes to EOF practice. In Phase 4, median time to commencement of full diet improved to postoperative Day 0. Patients prescribed a full diet on operation notes increased from 0% to 82%. Conclusions: The present study successfully identified and overcame local barriers to improve EOF practices to align with guideline recommendations.
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Journal Title
Nutrition & Dietetics
Volume
75
Issue
4
Copyright Statement
© 2018 Dietitians Association of Australia. This is the peer reviewed version of the following article: Early oral feeding after colorectal surgery: A mixedmethods study of knowledge translation, Nutrition & Dietetics, Vol. 75: pp. 345–352, 2018, which has been published in final form at 10.1111/1747-0080.12473. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving (http://olabout.wiley.com/WileyCDA/Section/id-828039.html)
Subject
Nutrition and dietetics
Health services and systems
Public health
Food sciences
Clinical nutrition
Early oral feeding
Enhanced recovery after surgery
Postoperative care