Implementing the PEP uP Protocol in Critical Care Units in Canada: Results of a Multicenter, Quality Improvement Study

Heyland, Daren K. MD, MSc
Dhaliwal, Rupinder RD
Lemieux, Margot RD
Wang, Miao MSc
Day, Andrew G. MSc

From the ¹Clinical Evaluation Research Unit, Kingston General Hospital, Kingston, Ontario, Canada; ²Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada; and ³Department of Medicine, Queen's University, Kingston, Ontario, Canada.

Financial disclosure: Nestlé provide partial funding for this project and provided 4 of the 8 PEP uP sites with products (Peptamen 1.5 and Beneprotein).

Received for publication January 30, 2014; accepted for publication March 24, 2014.

This article originally appeared online on April 18, 2014.

Corresponding Author:

Daren K. Heyland, MD, MSc, Kingston General Hospital, Angada 4, 76 Stuart St, Kingston, ON K7L 2V7, Canada.

Email: [email protected]

Journal of Parenteral and Enteral Nutrition 39(6):p 698-706, August 2015. | DOI: 10.1177/0148607114531787

Abstract

Background:

Previous studies have documented widespread iatrogenic underfeeding in intensive care unit (ICU) patients. In an experimental setting, we demonstrated the safety and efficacy of a novel enteral feeding protocol designed to overcome the main barriers to adequate delivery of enteral nutrition (EN), the Enhanced Protein-Energy Provision via the Enteral Route Feeding Protocol (PEP uP protocol). The purpose of this article is to describe our experience with implementing this feeding protocol under “real-world” settings in Canada.

Materials and Methods:

This study is a multicenter quality improvement initiative with a concurrent control group. Selected ICUs implemented the PEP uP protocol, and nutrition practices and outcomes were compared with a concurrent control group of ICUs.

Results:

In 2013, of the 24 ICUs from Canada that participated in the International Nutrition Survey, 8 implemented the PEP uP protocol and the remaining 16 served as concurrent control sites. Patients at PEP uP sites received 60.1% of their prescribed energy requirements from EN compared with 49.9% in patients from control hospitals (P = .02). In addition, patients in PEP uP protocol sites received more protein from EN (61.0% vs 49.7% of prescribed amounts; P = .01), were more likely to receive protein supplements (71.8% vs 47.7%; P = .01), and were more likely to receive >80% of their protein requirements by day 3 (46.1% vs 29.3%; P = .05) compared with patients in control hospitals.

Conclusions:

In the real-life setting, the PEP uP protocol can improve the delivery of EN to critically ill patients. (JPEN J Parenter Enteral Nutr. 2015;39:698-706)