Prevention and management of enteral nutrition-associated vomiting in patients on mechanical ventilation: a best practice implementation project

Introduction: Mechanically ventilated patients frequently experience enteral nutrition–associated vomiting (ENAV), increasing the risk of regurgitation, aspiration, and failure to meet nutritional targets. Aim: This evidence implementation project aimed to bridge the gap between current clinical practices and best practices for ENAV prevention and management, ultimately reducing its incidence in mechanically ventilated patients. Methods: This project used the JBI Evidence Implementation Framework, which follows three stages. The first stage involved a baseline audit using 15 evidence-based criteria derived from current guidelines and literature. This audit evaluated current practices for preventing and managing enteral ENAV in mechanically ventilated patients, guided by the i-PARIHS framework. The second stage involved analyzing the baseline audit results, identifying barriers to compliance, and developing and implementing strategies to address them. Strategies included nurse education and competency training, development of a standardized ENAV protocol and bedside checklist, implementation of intra-abdominal pressure monitoring, and optimization of nursing workflow. In the third stage, a follow-up audit was conducted using the same criteria and data collection methods to evaluate changes in practice. Project participants included 22 nurses and 28 patients. Results: Compliance improved across multiple criteria in the follow-up audit. Notably, criteria 5 and 13–15 increased from 0% at baseline to 67.86%, 97.87%, 81.93%, and 76.19%, respectively. Conclusion: Implementing evidence-based practices reduced ENAV incidence, strengthened nurses’ competencies in prevention and management, and promoted the broader integration of evidence-based practice within the hospital. The standardized protocol developed in this project represents a promising strategy, with its structured framework facilitating consistent care. However, the resource requirements warrant consideration for successful implementation. Spanish abstract: https://links.lww.com/IJEBH/A728