Department of Nutrition and Dietetics, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
School of Allied Health Sciences, Griffith University, Gold Coast, Queensland, Australia.
Nutr Diet. 2018 Sep;75(4):345-352. doi: 10.1111/1747-0080.12473. Epub 2018 Sep 5.
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.
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.
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%.
The present study successfully identified and overcame local barriers to improve EOF practices to align with guideline recommendations.
循证指南建议在结直肠手术后 24 小时内进行早期口服喂养（EOF），即给予不限饮食。本研究旨在了解结直肠手术后的局部术后喂养实践；确定 EOF 实施的障碍；选择、调整和实施利益相关者参与策略，以促进 EOF 的采用；并评估实践的变化。
本研究采用纵向混合方法，以知识转化框架为指导。第 1 阶段通过术后饮食审核 1 和 2 评估问题的性质。第 2 阶段，工作人员访谈确定了 EOF 实施的障碍。第 1 阶段和第 2 阶段的结果反馈给第 3 阶段的策略。在审核 3 和 4 中监测知识吸收情况。第 4 阶段评估审核 5 的结果。
第 1 阶段，审核 1 和 2 中，开始全饮食的中位时间分别为术后第 4 天和第 3 天。第 2 阶段确定了 EOF 障碍，包括饮食升级实践的差异和对医院饮食的不同理解。第 3 阶段，实施了改善 EOF 的计划策略：（i）描述当地医院饮食的教育课程；（ii）在手术记录上开医嘱给予全饮食；（iii）教育课程向护理人员描述 EOF 实践的变化。第 4 阶段，开始全饮食的中位时间缩短至术后第 0 天。在手术记录上开医嘱给予全饮食的患者比例从 0%增加到 82%。
本研究成功地发现并克服了改善 EOF 实践以符合指南建议的本地障碍。
